^^  r 


TUFTS   UNIVERSITY   LIBRARIES 


3  9090  014  531    236 


Webster  Family  Library  of  Veterinary  Medicine 
Cummings  School  of  Veterinary  Medicine  at 
Tufts  University 


VETERINARY  MEDICINE  SERIES 

No.  9 
Edited  by  D.  M.  CAMPBELL 


WOUND  TREATMENT 


BY 

LOUIS  A.  MERILLAT,  V.S.. 

E.  WALLIS  HOARE,  F.R.C.V.S., 

AND  OTHERS 


Chicago 

AMERICAN  JOURNAL  OF  VETERINARY  MEDICINE 

1915 


l\ 

WS 


CorYRIGHT,    1915 
BY 

D.  M.   Campbell 


PREFACE 

The  treatment  of  wounds  in  the  hands  of  the  average 
veterinarian  has  not  improved  as  much  in  the  last  dec- 
ade as  have  other  branches  of  purely  operative  surgery. 
A  score  of  years  ago,  few  veterinarians  expected  that 
wounds  made  in  the  course  of  their  operations  could 
be  healed  without  infection.  Now,  the  more  successful 
practitioners  reproach  themselves  if  a  wound  of  their 
own  making  develops  sepsis.  The  treatment  of  acci- 
dental wounds,  on  the  other  hand,  is  much  the  same 
now  in  the  practice  of  most  veterinarians  as  it  was  a 
double  decade  ago — that  is,  they  are  treated  by 
washes,  ointments,  or  dusting  powders,  as  the  inclina- 
tion of  the  practitioner  may  direct,  and  seldom  is  a 
real  conscious  effort  made  to  render  them  germ-free, 
suture  them  up,  and  procure  healing  by  first  intention 
without  the  development  of  sepsis. 

This  average  of  conditions  is  not  true  of  the  work  of 
all,  and  it  is  for  the  purpose  of  placing  the  methods  used 
by  a  number  of  the  most  successful  practitioners  in  the 
hands  of  the  whole  profession  that  this  little  volume  has 
been  issued.  It  comprises  the  better  articles  on  the  use 
of  antiseptics,  suturing  and  treatment  of  wounds  in  gen- 
eral, that  have  appeared  in  the  American  Journal  of 
Veterinary  Medicine  during  the  past  four  or  five  years. 
The  editor  is  convinced  that  the  treatments  herein  given 
are  practical  for  the  average  practitioner,  and  their  care- 
ful study  will  prove  of  much  value  to  him. 

D.  M.  C. 

Evanston,  Illinois, 
September,  1915. 


CONTENTS 


Disinfectants    xVNd    Their    Standardization — By 

Watson  Lewis 7 

Bactericidal  Properties  of  Common  Antiseptics 
AND  Disinfectants — By  H.  Lothe  and  B.  A. 

Beach 13 

Antiseptics,  Past  and  Present,  in  Wound  Treat- 
ment— By  E.  Wallis  Hoare 25 

Suppression  of  Hemorrhage — By  E.  Wallis  Hoare .     57 

Treatment  of  Wounds — By  L.  A.  Merillat 65 

Wound  Healing — By  A.  T.  Kinsley 125 

Repair  of  Wounds — By  Williayn  Brady 131 

Surgery  in  Wound  Treatment — By  JoJm  Ernst. .  .   137 
Practical    Surgical    Cleanliness — By    Mart.    R. 

Steffen  145 

VuLNERARiES — By  Douglas  H.  Stewart 149 

Practical  Wound  Applications — By  A.  W. 

Waldron,  Jr 153 

Abdominal  Wounds  of  Animals — By  J.  V.  Lacroix  155 

Open  Joints — By  J.  N.  Frost 165 

Open  Joints — By  Mart.  R.  Steffen 173 

Tetanus  Following  Surgical  Wounds — By  Henry 

Smith,  V.H.S 177 

Favorite  Wound  Treatments — By  Several  Writers 

179,  180,  181 

Index 183 


DISINFECTANTS  AND  THEIR 
STANDARDIZATION 

By  WATSON  LEWIS,  D.V.M,  Saint  Paul,  Minnesota 

An  antiseptic  prevents  the  growth,  of  germs,  while  a 
disinfectant  kills  them.  It  is  hard  to  say  just  where 
antiseptic  action  leaves  off  and  disinfectant  begins, 
for  they  are  so  closely  allied  that  the  terms  are  com- 
monly used  synonymously.  It  is  a  well  known  fact 
that  a  substance  may  cause  a  marked  inhibition  of 
bacterial  growth  and  still  be  of  little  value  as  a  germ 
destroyer.  For  instance,  turpentine  will  retard  the 
growth  of  spores  in  solutions  of  1  to  75,000,  while 
carbolic  acid  only  retards  in  a  solution  stronger  than 
1  to  1,250.  This  powerful  antiseptic  action  explains 
the  high  efficiency  of  turpentine  in  flatulent  conditions 
both  in  human  and  in  veterinary  medicine. 

Nothing  is  used  more  frequently  in  veterinary  sur- 
gery than  antiseptics  and  disinfectants,  many  of  which 
are  standardized.  However,  such  is  not  the  case  with 
coal  tar  and  allied  disinfectants,  for  here  no  standard 
has  been  adopted  to  protect  the  consumer  against 
fraud. 

These  preparations  are  now  offered  on  the  market 
at  prices  varying  from  fifty  cents  to  five  dollars  a  gal- 
lon. The  five-dollar  preparation  may  be  actually 
cheaper  than  the  fifty-cent  preparation,  because  of  its 
germicidal  value.  Accurate  test  shows  that  there  are 
preparations  fifteen  to  seventeen  times  more  efficient 
than  carbolic  acid,  but  they  do  not  sell  for  fifty  cents 
a  gallon. 


8  WOUND  TREATMENT 

The  question  now  arises,  ''How  are  we  to  know 
the  real  value  of  a  germicide?"  In  the  last  few  years, 
both  in  this  country  and  in  Europe,  there  have  been 
rapid  advancements  made  in  the  accurate  standard- 
ization of  disinfectants.  It  is  time  that  the  old  state- 
ments in  textbooks*  that  bichlorid  of  mercury  kills 
anthrax  in  so  many  hours,  and  Streptococcus  pyogenes 
in  so  many  minutes,  should  be  discarded.  The  results 
depend  entirely  on  the  strains  of  the  organisms  tested 
and  the  method  used. 

One  strain  of  Streptococcus  pyogenes  may  be  killed 
in  five  minutes  while  another,  by  the  same  method, 
will  require  twice  the  time. 

Carbolic  acid  and  the  salts  of  the  heavy  metals,  such 
as  silver,  copper,  and  mercury,  have  been  mostly  used 
as  disinfectants.  There  is  now  a  tendency  to  discard 
these  for  the  more  easily  applied  preparations,  as  their 
general  fault  lies  in  their  lack  of  efficiency  in  the  pres- 
ence of  organic  matter — that  is,  blood  and  pus. 

Another  group  of  disinfectants  not  used  to  any  ap- 
preciable extent  but  possessing  high  efficiency,  is  the 
essential  oils.  They  owe  their  germicidal  value  to 
their  phenol  content,  which,  in  some  instances,  is  very 
high.  Thymol,  for  example,  which  is  a  phenol  obtained 
from  the  oil  of  thyme,  is  twenty-five  times  more  pow- 
erful than  carbolic  acid.  It  is  unfortunate  that  the 
expense  of  these  oils  and  the  inconvenience  of  apply- 
ing them  have  limited  their  use,  for  they  are  only 
slightly  toxic,  do  not  coagulate  organic  matter  to  any 
appreciable  extent,  and  are  only  slightly  irritating. 

The  germicidal  value  of  most  of  the  commercial 
coal-tar  disinfectants  is  duo  to  the  cresols — paracresol, 
metacresol,  and  orthocresol — which  are  variable  in  their 
germicidal  efficiency. 


DISINFECTANTS— STANDARDIZATION        9 

Paracresol  and  metacresol  have  much  more  germi- 
cidal power  than  orthocresol,  and  the  amount  of  each 
present  in  the  coal-tar  disinfectants  may  vary  mark- 
edly in  different  lots.  Therefore  it  is  necessary  to 
determine  the  percentage  of  each,  in  each  lot,  by  frac- 
tional distillation. 

Several  methods  have  been  advanced  for  the  testing 
of  the  germicidal  value  of  disinfectants,  and  lately 
much  work  has  been  done  toward  standardizing  such 
methods. 

The  methods  of  the  Lancet  commission  and  Rideal- 
Walker,  and  that  of  Anderson  and  McClintic  of  the 
United  States  Public  Health  Service,  have  all  been  em- 
ployed. The  Anderson-McClintic  method  is  a  modifica- 
tion of  the  Rideal- Walker  method  to  eliminate  some  of 
the  variations  which  may  be  obtained  in  the  use  of  that 
test. 

In  all  such  tests  the  great  difficulty  lies  in  finding  a 
procedure  by  which  the  exact  value  of  the  disinfectants 
may  be  determined,  and  a  proper  relative  standard  se- 
cured in  the  laboratory. 

It  must  be  borne  in  mind  that  such  a  test,  no  matter 
how  painstakingly  and  elaborately  worked  out,  is  at  the 
best  but  a  laboratory  test,  and  is  only  an  indication  of 
the  relative  possibilities  of  the  disinfectants  under  the 
varying  conditions  met  with  in  practice. 

However,  it  may  be  said  safely  that  the  Anderson- 
]\IcClintic  method  gives  a  basis  for  successful  testing  of 
disinfectants  and  at  the  least  will  enable  us  to  standard- 
ize their  action  toward  the  typhoid  organism,  relative 
to  the  action  of  phenol  under  the  same  conditions. 

In  using  the  Anderson-lMcClintie  method  it  is  most 
essential  that  the  exact  recommendations  of  the  authors 
be  carried  out  to  the  minutest  detail.  Lack  of  attention 
to  the   different  factors  concerned  in   the  examination 


10  WOUND  TREATMENT 

of  disinfectants  is  responsible  for  most  of  the  discrep- 
ancies in  results  obtained  by  different  workers  with 
the  same  disinfectant.  Close  attention  to  the  details  of 
the  method  used  is  the  only  way  in  which  uniform  results 
can  be  secured. 

The  factors  which  bring  about  the  greatest  variance 
in  results  obtained,  and  which  must  be  considered  of 
the  most  importance  in  the  conduct  of  the  test,  are  (1) 
the  organism  used,  (2)  temperature  of  the  experiment, 
(3)  amount  of  culture,  (4)  amount  of  disinfectant,  and 
(5)  the  media  used  in  subculture,  (6)  standardized 
solution  of  phenol. 

The  coefficient  obtained  by  different  species,  and  by 
different  strains  of  same  species,  may  vary  greatly,  so 
it  is  essential  that  one  species  be  adopted  and  the  cul- 
tivation of  the  strain  employed  be  as  nearly  standard- 
ized as  possible.  For  this  reason  the  Hopkins  strain  of 
B.  typhosus  is  best  employed.  It  is  cultivated  on  stand- 
ard extract  broth  made  from  Liebig's  extract  of  beef 
in  accordance  with  the  methods  adopted  by  the  Amer- 
ican Public  Health  Association  for  water  analysis.  It  is 
important  that  the  reaction  of  the  medium  be  just  11.5. 
One  loopful  of  4-millimeter  platinum  loop  of  the  cul- 
ture is  carried  over  every  twenty-four  hours  on  three 
successive  days.  Before  being  added  to  the  disinfectant 
the  culture  is  filtered  through  sterile  filter  paper  and 
brought  to  a  temperature  of  20  degrees  Centigrade  in 
a  water  bath. 

One  tenth  of  a  cubic  centimeter  of  the  culture  is  used, 
added  to  5  cubic  centimeters  of  the  disinfectant  dilution 
at  a  temperature  of  20  degrees  Centigrade.  Measure 
the  amount  of  culture  with  a  pipette  graduated  to  1-10 
cubic  centimeter. 

When  the  proper  dilutions  of  the  disinfectant  to  be 
tested   and   the   phenol    controls   have   been   made    and 


DISINFECTANTS— STANDARDIZATION       11 

placed  ill  their  respective  test  tubes,  all  is  placed  in  a 
water  bath  so  that  the  solutions  may  be  brought  to  a 
temperature  of  20  degrees  Centigrade.  A  standard  so- 
lution of  pure  phenol  is  made  and  standardized  by  the 
United  States  Pharmacopeia  method  to  contain  a  five 
per-cent  solution  by  weight.  Dilutions  are  made  fresh 
from  this  each  day.  When  everything  is  ready,  1-10 
cubic  centimeter  of  the  culture  is  added  by  the  pipette 
to  each  of  the  dilutions  in  the  seed  tubes. 

The  solutions  are  planted  from  the  seed  tubes  into 
the  culture  tubes  every  two  and  one-half  minutes  up 
to  fifteen  minutes,  and  for  this  a  4-millimeter  platinum 
loop,  United  States  standard,  23-gauge  wire  is  used. 

In  adding  the  culture  to  the  dilution  the  best  method 
is  to  tip  the  test  tube  at  an  angle  of  forty-five  degrees, 
lightly  touch  the  pipette  against  the  side  of  the  tube 
below  the  surface  line,  and  then  shake  gently.  The 
broth  tubes  are  placed  in  the  incubator  at  37  degrees 
Centigrade  for  forty-eight  hours. 

The  mean  between  the  strength  and  time  coefficients 
is  used  for  determining  the  coefficient.  To  determine 
the  coefficient,  the  figure  representing  the  degree  of  dilu- 
tion of  the  weakest  strength  of  the  disinfectant  that 
kills  within  two  and  one-half  minutes  is  divided  by 
the  figure  representing  the  degree  of  dilution  of  the 
w^eakest  strength  of  the  phenol  control  that  kills  within 
the  same  time.  The  same  is  done  for  the  weakest 
strength  that  kills  in  fifteen  minutes.  The  mean  of  the 
two  is  the  coefficient. 

As  has  been  stated  before,  the  coefficient  simply  rep- 
resents the  germicidal  power  of  the  disinfectant  tested, 
relative  to  the  power  of  phenol  on  the  same  organisms 
under  the  same  conditions,  and  should  be  accepted  only 
as  such. 


12  WOUND  TREATMENT 

However,  it  is  the  best  we  have  at  present,  and  great 
thanks  are  due  to  Rideal-Walker  and  to  Anderson- 
MeClintic  for  carrying  ns  this  far  in  obtaining  a  pro- 
cedure by  which  we  may  begin  to  standardize  disin- 
fectants. 


BACTERICIDAL  PROPERTIES  OF  COM- 
MON ANTISEPTICS  AND 
DISINFECTANTS 

By   H.  LOTHE,  D.V.M.,  and  B.  A.  BEACH,   D.V.M., 
Madison,  Wisconsin 

A  new  era  in  surgery  began  with  the  work  of  Lister, 
who  in  1867  studied  the  effect  of  disinfection  upon 
wound  healing  and  introduced  carbolic  acid  as  a  dis- 
infectant. As  the  science  of  bacteriology  developed,  our 
knowledge  of  disinfectants  and  disinfection  increased 
and  will  continue  to  increase  and  may  change  as  new 
bacteriological  data  are  collected  that  change  the 
science  of  bacteriology.  It  therefore  follows  that  the 
final  word  on  disinfection  has  not  yet  been  said,  hence 
a  conclusive  statement  of  our  knowledge  of  disinfection 
cannot  be  given.  Nevertheless,  sufficient  experimental 
data  have  already  been  collected  to  determine  certain 
fundamental  principles  upon  which  scientific  disinfec- 
tion is  based.  Judgment  as  to  the  value  of  any  disin- 
fecting agent  must,  therefore,  be  made  largely  from  a 
bacteriological  point  of  view. 

As  we  all  know,  the  fundamental  principle  of  disin- 
fection is  the  destruction  of  bacteria  by  means  of  chem- 
icals or  heat  (commonly  called  sterilization).  In  this 
article  disinfection  by  means  of  chemicals  only  will  be 
considered.  Chemicals  are  used  for  these  purposes :  (1) 
to  render  innocuous  buildings  and  other  inanimate  ob- 
jects that  have  come  in  contact  with  germs  of  various 
infectious  diseases;  and  (2)  to  prevent  the  entrance  of 
organisms   to   the   animal   body   and   to  kill   organisms 

13 


14  WOUND  TREATMENT 

that  have  already  gained  entrance  to  the  animal  body. 
The  latter  concerns  the  surgeon,  while  the  former  is 
a  matter  of  primary  interest  to  the  sanitarian. 
A  veterinarian  must  necessarily  act  in  both  of  these 
capacities.  The  fundamental  principles  of  disin- 
fection are  the  same  for  both  the  surgeon  and  the 
sanitarian,  although  each  has  peculiar  problems  that  do 
not  concern  the  other.  To  the  surgeon  the  question  of 
toxicity  of  the  disinfectant  to  higher  animal  life  be- 
comes an  important  question,  while  to  the  sanitarian  this 
is  not  so  important.  The  ideal  disinfectant  is  one  abso- 
lutely non-toxic  to  the  animal  body  but  highly  toxic  to 
bacteria.  Surgeons  are  still  looking  for  this  ideal  dis- 
infectant. 

Disinfectant  and  Antiseptic 

For  the  sanitarian  chemicals  that  kill  bacteria  are 
ideal,  and  are  known  as  disinfectants.  Such  agents  are, 
however,  as  a  rule,  too  toxic  for  the  surgeon,  who  uses 
agents  that  prevent  the  growth  of  bacteria  and  are  known 
as  antiseptics.  The  same  chemical  agent  may  be  both 
an  antiseptic  and  a  disinfectant,  depending  upon  con- 
centration. 

Cauterization 

The  surgeon  occasionally  uses  agents  that  are  toxic 
to  tissues  which  are  known  as  caustics.  These  agents 
kill  both  tissue  and  bacteria  cells,  and  conditions  ob- 
tain at  times,  such  as  bites  from  rabid  dogs,  when  this 
drastic  method  is  of  primary  importance. 

Factors  Affecting  the  Action  of  Antiseptics 

There  are  various  factors  that  affect  the  action  of  dis- 
infectants and  antiseptics,  as  follows: 


BACTERICIDAL  PROPERTIES  15 

1.  Type  op  OrGx\nism. — In  the  early  days  of  antisep- 
sis, disinfectants  were  tested  baeteriologieaily  with  the 
idea  of  discovering  some  chemical  agent  that  Avould 
destroy  all  known  bacteria  when  nsed  in  a  weak  solution. 
No  such  universal  antiseptic  has  been  found.  On  the 
contrary,  it  has  been  found  that  different  antiseptics 
have  a  selective  action  upon  certain  types  of  organisms. 
For  example,  bichlorid  of  mercury  is  a  most  powerful 
disinfectant  for  anthrax,  but  has  only  a  weak  action 
on  tubercle  bacilli  and  is  much  less  effective  than  some 
other  drugs  (creolin,  lysol,  alcohol)  for  superficial  dis- 
infection of  the  skin,  while  carbolic  acid  is  relatively 
ineffective  against  tetanus  bacilli,  anthrax  spores,  and 
tubercle  bacilli.  It  therefore  follows  that  in  disinfec- 
tion the  different  organisms  and  bacteria  must  be  con- 
sidered individually.  In  general,  it  can  be  said  that 
spore-bearing  bacteria  require  stronger  disinfectants 
than  non-spore  bearers.  Here  again  individual  differ- 
ences in  resistance  of  species  of  spores  and  vegetative 
forms  manifest  themselves.  It  is,  therefore,  difficult  to 
make  a  comparative  table  of  individual  drugs.  In  gen- 
eral, the  strongest  disinfectants  w^hich  also  destroy  spores 
are  mercuric  chlorid,  silver  nitrate,  iodin,  creolin,  lysol, 
liquor  cresolis  compound  and  other  cresol  preparations, 
and  formalin.  The  weaker  disinfectants  which  kill  only 
spore-free  organisms  are  coal  tar,  carbolic  acid,  salicylic 
acid,  dyes,  boric  acid,  and  calcium  lyes  (whitewash)  and 
acids. 

Individual  Resistance  of  Organisms. — The  individual 
resistance  of  different  organisms  varies.  Some  infectious 
agents  are  very  readily  destroyed  w^hile  others  are  very 
resistant.  For  practical  purposes  disease-producing 
micro-organisms  may  be  divided  into  two  groups  on  the 
basis  of  their  power  to  resist  disinfection. 


16  WOUND  TEBATMENT 

1.  REQUIEING  STRONG  DISINFECTANTS- 

Anthrax  spores 
Tetanus  spores 
Tubercle  bacilli 
Blackleg  spores 
Rabies  virus 

2.  EEQUIEING    WEAKER   DISINFECTANTS- 
Glanders  bacilli 

Hemorrhagic   septicemia   bacilli 
Abortion  bacilli 
Foot.and-=„outh  disease  virus,  and  other  bacilli 

Pus  organisms   (Staphylococci  and  Streptococci)   oc 

They    however,  require  stron,  dlSctantl    "  ^~ 
2    TEMPERATURE.-The    higher   the    temperature    the 
greater  .s  the  disinfectant  property  of  a  glen  chemiei 
Practical   application   of  this  is  madp  ST  '^^"'"'f'- 

are  most  efficient.     Concentrations  of  ten  to    wenty " 

e.s;  t^iriLeV-:  :r  ttr„-rcr 

eentrafons  where  emulsification  is  compSe  The  dil 
fee  .on  coefficient  varies  directly  as  concern t'ti^bu.n 
tha fi:  r;7f «°"  ««  ratio  of  increase  is  sma  ler- 
that  IS,  a  twenty-per-cent  solution  has  not  ten  times  the 
dxs.nfectant  properties  of  a  two-per-cent  solution 
of  time  T™''  °'  ACTIOK.-For  action,  a  certain  lapse 

a  t  eTtirortr"'  t"^  ^^^'^  ^^'* «-  -<^'-d- 

on     he  other      wT         '  '"^  *^  '''^'  ''  '>'-^-"-« 
the  other.     W.th  some  disinfectants  the  action  on 


BACTERICIDAL  PROPERTIES  17 

certain  organisms  is  almost  immediate,  while  with  others 
a  greater  lapse  of  time  is  necessary. 

5.  Presence  of  Or<5ANIC  jMatter. — Under  practical 
conditions  disinfectants  are  used  in  the  presence  of  or- 
ganic matter,  and  it  has  been  found  that  considerably 
higher  concentration  and  greater  length  of  time  are 
necessary  for  most  disinfectants  under  such  conditions. 
Such  organic  material  as  blood,  manure,  and  urine  are 
often  present  where  disinfection  and  antisepsis  are  prac- 
ticed. These  contain  chemical  bodies  that  unite  with  the 
antiseptic  used,  rendering  it  inert.  It  is  therefore  neces- 
sary to  use  enough  disinfectant  to  combine  with  the 
organic  matter  and  enough  more  to  act  as  an  antiseptic 
and  disinfectant.  This  factor  will  naturally  vary  with 
the  kind  and  amount  of  organic  matter  present. 

To  summarize,  then,  w^e  find  that  the  disinfectant 
properties  of  any  given  chemical  depend  upon : 

1.  Type  of  organism 

2.  Temperature   at  which  it  acts 

3.  Concentration 

4.  Length    of    time    acting 

5.  Amount  and   character   of  organic   matter 

Earlier  in  this  article  mention  was  made  of  the  fact 
that  scientific  disinfection  was  based  entirely  upon  bac- 
teriological tests.  In  determining  the  value  of  any  given 
disinfectant  it  therefore  becomes  necessary  to  take  into 
consideration  each  of  the  five  above-mentioned  factors  so 
that  a  comparison  of  different  antiseptics  can  be  made 
on  the  same  basis.  It  is  necessary  that  they  all  act  upon 
the  same  organism,  at  the  same  temperature  and  con- 
centration, for  the  same  length  of  time,  and  in  the 
presence  of  the  same  amount  and  composition  of  organic 
matter. 


18  WOUND  TREATMENT 

Hygienic   Laboratory   Phenol    Coefficient 

A  method  of  standardizing^  or  testing  antiseptics  has 
been  developed  and  described  by  Anderson  and  McClin- 
tic  in  Bulletin  82  of  the  Public  Health  and  Marine 
Hospital  Service,  Washington,  T>.  C,  known  as  the 
"Hygienic  Laboratory  Phenol  Coefficient"  method, 
which  takes  into  account  all  of  the  above-mentioned  fac- 
tors. It  is  sufficient  for  our  purpose  at  this  time  merely 
to  state  how  this  method  meets  these  requirements  with- 
out going  into  the  details  of  laboratory  manipulations. 

1.  Type    of    organism   used   is    a   twenty-four-hour   broth 

culture    of    B.    typhosus    (the    organism    of    typhoid 
fever    in   a   man) 

2.  Temperature   is   20   degrees    Centigrade 

3.  Concentrations  of  various  strength 

4.  Length  of  time  varies  from  two  and  one-half  to  fifteen 

minutes   for   each   dilution   or   concentration 

5.  Organic  matter  consisting  of  two  per  cent  of  peptone 

and  one  per  cent  of  gelatin  is  used. 

To  give  more  information  regarding  any  given  dis- 
infectant, this  method  prescribes  that  its  germicidal 
properties  be  determined  upon  typhoid  both  in  the  ab- 
sence and  in  presence  of  organic  matter. 

For  purposes  of  comparison  the  results  are  expressed 
in  figures  known  as  the  "hygienic  laboratory  phenol  co- 
efficient," which  simply  means  the  germicidal  proper- 
ties of  the  disinfectant  in  question  expressed  in  terms 
of  phenol  or  carbolic  acid,  reducing  the  value  of  all  dis- 
infectants to  a  common  language  or  medium  of  ex- 
change, so  to  speak,  just  as  the  value  of  wheat,  beef,  and 
gasoline  is  expressed  in  terms  of  dollars  and  cents  rather 
than  expressing  the  value  of  a  bushel  of  wheat  in  pounds 
of  beef,  or  pounds  of  beef  in  gallons  of  gasoline.  The 
phenol  coefficient,  then,  givei^  you  the  bactericidal  prop- 
erty of  the  disinfectant  in  question  compared  to  phenol. 


BACTERICIDAL  PROPERTIES 


19 


The  table  on  this  page  shows  the  results  obtained  by 
this  method  with  a  well-lvnown  antiseptic  with  which 
many  of  you  are  familiar. 


Creolin-Pearson- 


-Results  of  a  Test  without  Organic 
Matter 


(+    means  growth;  —  means  no  growth) 
Time  culture  exposed  to 
action  of  disinfectant  Phenol 

for  minutes  coefficient 


Sample                       Dilution   21       5     11     10    12S    15 

200  +  400 

Phenol 

\    1:80 

1:90 

1:100 

1:110 

"1:200 
1:225 
1:250 
1:300 
1:350 
1:400 
1:450 

[1:500 

+ 
+ 
+ 

+ 
+ 
+ 
+ 
+ 
+ 
+ 

+ 
+ 

+ 
+ 
+ 
+ 

+ 

+ 

+ 
+ 
+ 
+ 

+ 

+ 

+ 
+ 
+ 

+ 
+ 

+ 
+ 



+ 
+ 

80 -f  100 

2 
2.50  +  4.00 

Creolin \ 

2 
3.25 

Results  of  a  Test  with  Organic  Matter 


Time  culture  exposed  to 
action  of  disinfectant  Phenol 

for  minutes  coefficient 


Sample                       Dilution   2i       5     7i     10    12J    15 

160  +  275 

[    1:80 
1:90 

— 

— 

— 

— 

— 



+ 

+ 

— 

— 

— 

— 

80  +  90 

Phenol i 

1-100 

+ 
+ 

+ 
+ 

+ 

+ 

+ 
+ 

+ 
+ 

+ 
+ 



1:110 

2 

1:150 

— 

— 

— 

— 

— 

2.00  +  3.05 

1  -IfiO 

1:180 

+ 











2 

1:200 

+ 

— 

— 

— 

— 



2.52 

Creolin    J 

1:225 

+ 

+ 

— 

— 

— 



1:250 

+ 

+ 

— 



— 

— 

1:275 

+ 

+ 

+ 

— 

— 

— 

1:300 

+ 

+ 

+ 

+ 

+ 

+ 

This  table  illustrates  very  clearly  the  effect  of  the 
various  factors  that  influence  the  action  of  a  disin- 
fectant.   For  instance,  in  the  1  to  80  dilution  of  phenol 


20  WOUND  TREATMENT 

there  was  no  growth  in  two  and  one-half  minutes;  in 
the  1  to  90,  however,  there  Avas,  showing  the  effect  of 
concentration.  The  lower  table  shows  the  effect  of  or- 
ganic matter.  For  example,  it  took  the  1  to  90  dilution 
five  minutes  to  kill  against  two  and  one-half  minutes 
without  organic  matter,  or  just  twice  as  long.  The  1  to 
100  dilution  failed  to  kill  in  two  and  one-half  minutes 
but  was  bactericidal  in  fifteen  minutes,  showing  the 
effect  of  exposure. 

Now  the  question  arises  as  to  what  practical  value 
such  tables  as  these  have.     There  are  upon  the  market 
innumerable  kinds  of  disinfectants  put  up  by  different 
commercial  houses  at  greatly  varying  prices,  based,  not 
upon  their  efficiency  as  germ  killers,  but  upon  the  per- 
centage of  profit  the  manufacturer  thinks  he  ought  to 
get.       For     example,     mixtures     containing     varying 
amounts   of   creolin   are   upon   the   market.     All   have 
the  property  of  forming  a  white  emulsion  with  water 
and  in  addition  a  more  or  less  aromatic  odor.     The  idea 
seems  to  have  gained  precedence  that  odor  and  disinfect- 
ing properties  go  hand  in  hand.     The  more  penetrating 
the  odor  and  the  more  milky  the  solution,  the  better  the 
antiseptic,  seems  to  be  the  belief.     There  are  prepara- 
tions on  the  market  possessing  both  the  latter  qualities 
to  a  superlative  degree  but  having  little  action  other 
than  imparting  a  pronounced  odor  to  your  medicine  case 
and  clothing.     The  only  true  criterion  of  the  value  of 
any  given  preparation  as  a  germ  killer  is  a  bacteriological 
determination.    Every  practicing  veterinarian  should  in- 
sist upon  knowing  the  phenol  coefficient  of  the  antiseptic 
purchased.     The  time  is  coming  when  all  commercial  con- 
cerns will  place  the  coefficient  upon  their  labels,  as  some 
houses  are  already  doing. 

When  the  phenol  coefficient  and  price  per  gallon  of  a 
number  of  disinfectants  are  known,  it  is  possible  to  cal- 


BACTERICIDAL  PROPERTIES  21 

ciilate  from  the  price  of  pure  phenol  which  will  be  the 
most  economical  to  buy.  It  is  apparent  to  any  one  that 
it  is  better  to  pay  sixty  cents  a  gallon  for  disinfectant 
"A"  than  thirty  cents  per  gallon  for  disinfectant  "B" 
if  "A"  has  four  times  the  efficiency  of  "B." 

To  determine  the  cost  per  100  units  of  efficiency  of  any 
preparation  as  compared  to  phenol,  divide  the  cost  per 
gallon  by  the  cost  per  gallon  of  pure  phenol ;  this  gives 
the  cost  ratio  of  the  tw^o.  The  efficient  ratio  of  the  two 
is  obtained  by  dividing  the  phenol  coefficient  of  the  prep- 
aration by  the  phenol  coefficient  of  phenol,  which  is  al- 
ways 1,  since  it  is  the  unit.  The  efficiency  ratio  is  there- 
fore always  the  phenol  coefficient.  The  cost  ratio  divided 
by  the  efficiency  ratio  (the  phenol  coefficient)  gives  the 
cost  of  the  disinfectant  per  unit  efficiency  of  phenol. 
Multiplying  by  100  gives  the  relative  cost  per  100  units. 
Thus, 

Cost  of  disinfectant  per  gallon       coefficient  of  disinfectant 


Cost  of  phenol  per  gallon  coefficient  of  phenol   (  =  1) 

Cost  of  disinfectant  per  unit  of  efficiency  compared  to  phenol 
=  1. 
Multiplying  by  100  gives  coefficient  per  100  units  of  phenol. 

For  example,  the  cost  of  carbo-campho,  with  which 
most  veterinarians  are  familiar,  is  $2.50  per  gallon  and 
has  a  phenol  coefficient  of  .57 ;  the  cost  of  phenol  is  $3.25 
per  gallon,^  and  has  a  coefficient  of  1.     Then, 

2.50         .57 

^ =1.33. 

3.25  1 

Therefore  the  comparative  cost  of  carbo-campho  per 
unit  of  efficiency  and  phenol  is  1.33  :1 ;  or,  multiplying 
by  100,  we  get  133:100,  which  means  that  $1.33  worth 


^The  cost  of  phenol  is  considerably  higher  than  this  at  the 
present  time,  $4.95  per  g-allon,  due  to  the  war  conditions  abroad, 
but  it  was  deemed  best  to  quote  the  usual  price  rather  than  the 
unnatural  one  due  to  the  present  war  conditions. 


22  WOUND  TREATMENT 

of  carbo-campho  will  give  as  much  disinfecting-  efficiency 
as  a  dollar's  worth  of  phenol.  Likewise,  about  seven 
cents'  worth  of  crude  carbolic  acid  will  give  as  much 
disinfecting  power  as  a  dollar's  worth  of  pure  phenol. 
.  Such  figures  as  these  are  of  value  in  determining  the 
most  economical  disinfectant  to  buy,  based  upon  effi- 
ciency and  the  price  of  phenol. 

Naturally  these  figures  will  vary  as  the  price  of  phenol 
and  other  disinfectants  varies,  so  that  a  calculation  must 
be  made  to  fit  market  conditions  as  they  exist.  What 
may  be  the  cheapest  antiseptic  to  buy  to-day  may  not  be 
a  month  or  a  year  hence.  The  following  table  gives  fig- 
ures for  a  number  of  antiseptics  based  upon  prices  to- 
day: 

Relative  cost 

per  100  units 

Efficiency    of  Efficiency 

Disinfectant  Ratio  or       Comlpared 

Price  per    Cost       Ptienol         witti  pui'e 

Gallon     Ratio  Coefficient  carbolic  acid 

Crude  carbolic  acid^ 60  .1846  2.65  6.9 

Hygeno     95  .292  3.50  8.34 

Kresco  (P.  D.  &  Co.) 1.15  .353  3.92  9.00 

Zenoleum 1.25  .384  2.25  17.00 

Liquor  cresolis  compositus.  .  2.50  .769  3.00  25.6 

Trikresol    4.00  1.23  2.62  47.3 

Creolin   6.66  2.04  3.25  62.7 

Lysol     5.00  1.52  2.12  71.84 

Carbo-campho^    2.50  .76  .57  133.3 

Carbolic  acid    3.25  1.00  1.00  100.0 

In  this  paper  we  have  endeavored  to  bring  out  the  fol- 
lowing facts: 

1.  That  the  fundamental  principles  of  disinfection  are 
based  upon  bacteriological  facts  and  not  upon  physical 
appearance  or  odors  of  the  disinfectant. 

2.  That  the  action  of  antiseptics  is  affected  by 


'Piienol  coefficient  determined  at  Veterinary  Science  T^abor- 
atory,  College  of  Agriculture,  Madison,  Wis. 

2For  phenol  coefficient  of  other  disinfectants  in  this  table,  the 
writers  are  indebted  to  Bulletin  82,  Public  Health  and  Marine 
Hospital  Service. 


BACTERICIDAL  PROPERTIES  23 

(a)  Type  of  organism 
(h)  Temperature 

(c)  Concentration 

(d)  Duration  of  action  ( length  of  time  of  action) 

(e)  Amount  and  character  of  organic  matter  present. 

3.  That  there  is  a  method  of  accurately  determining 
the  bactericidal  properties  of  am^  given  antiseptic,  known 
as  the  "hygienic  laboratory  phenol  coefficient"  method 
and  described  by  Anderson  and  McClintic  in  Bulletin 
82  of  the  Public  Health  and  IMarine  Hospital  Service  of 
the  United  States. 

4.  That  the  phenol  coefficient  of  any  given  antiseptic 
or  disinfectant  may,  for  practical  purposes,  be  defined 
as  the  figure  representing  the  ratio  of  the  germicidal 
poAver  of  the  disinfectant  to  that  of  carbolic  acid,  both 
having  been  tested  under  the  same  conditions. 

5.  That  the  only  logical  method  of  purchasing  disin- 
fectants is  upon  the  basis  of  their  phenol  coefficients. 

6.  That  the  relative  cost  per  unit  of  efficiency  can  be 
calculated  by  use  of  the  phenol  coefficient.  That  is,  the 
relative  cost  of  any  number  of  antiseptics  compared  to 
carbolic  acid,  thus  telling  you  just  where  you  get  the 
most  for  your  money.  Thus  6.9  cents  will  buy  as  much 
disinfecting  power  in  crude  carbolic  acid  as  25.6  cents 
spent  for  liquid  cresolis  compositus  or  $1.33  spent  for 
carbo-campho  or  $1.00  spent  for  pure  phenol. 


ANTISEPTICS,    PAST    AND    PRESENT, 
IN  WOUND  TREATMENT 

By  E.  WALLIS   HOARE,  F.R.C.V.S.,  Cork.   Ireland 

In  ejecting  "Antiseptics,  Past  and  Present,"  as  a, 
theme  for  discussion,  I  venture  to  think  it  is  one  that 
will  prove  of  interest  to  every  practitioner;  certainly 
there  are  many  points  in  connection  with  it  which  offer 
ample  room  for  an  interchange  of  opinions,  ideas,  and 
experiences,  the  result  of  which  is  likely  to  prove  useful 
in  our  daily  work. 

I  freely  confess  that  one  of  my  reasons  for  choosing 
this  subject  is  to  ascertain  as  far  as  possible  to  what 
extent  the  principles  of  aseptic  surgery  can  be  applied 
to  animals.  I  am  quite  aware  that  in  certain  quarters 
it  is  held  that  aseptic  surgery  can  be  applied  to  animals, 
and  that  failures  in  this  direction  are  to  be  attributed 
to  want  of  care  on  the  part  of  the  practitioner,  or  to 
prejudice.  But  in  drawing  conclusions  on  matters  of 
this  kind  it  is  essential  to  possess  a  varied  experience  of 
surgery  under  conditions  favorable  and  unfavorable, 
both  in  town  and  country,  and  one  important  point  that 
I  shall  endeavor  to  demonstrate  will  be  with  reference 
to  the  effects  of  environment  and  certain  unalterable 
conditions  that  exist  in  connection  with  the  treatment 
of  wounds  in  our  patients. 

PROGRESS  IN  VETERINARY  SURGERY 

I  have  also  another  object  in  view :  many  medical  men 
and  not  a  few  of  the  laity  hold  the  erroneous  opinion 
that  veterinarians  do  not  take  the  trouble  to  practice 

25 


26  WOUND  TREATMENT 

aseptic  surgery;  we  are  constantly  asked  why  wounds 
do  not  heal  by  first  intention,  and  why  we  do  not  adopt 
this  or  that  measure  which  proves  so  successful  in  the 
case  of  wounds  in  man.  For,  owing  to  the  spread  of 
popular  knowledge,  the  ''man  in  the  street"  now  pro- 
fesses to  know  something  about  surgical  technic.  Horse 
owners,  through  reading  various  popular  works  on  vet- 
erinary science,  pretend  to  know  all  about  antiseptics, 
and  the  suggestions  that  are  often  made  to  us  when 
treating  wounds  are  grotesque  in  the  extreme. 

My  remarks  throughout  this  paper  will  be  specially 
directed  to  demonstrate  the  fact  that  veterinary  sur- 
geons do  appreciate  the  importance  of  aseptic  surgery, 
and  endeavor  to  carry  out  its  principles  as  far  as  cir- 
cumstances will  permit. 

Let  us  first  of  all  take  a  retrospective  view  of  veter- 
inary surgery  as  applied  to  the  treatment  of  wounds. 
That  marked  progress  has  been  made  is  a  fact  apparent 
to  even  the  most  pronounced  pessimist.  This  advance 
must  be  attributed  to  the  discoveries  of  Lister,  Although 
the  researches  of  this  eminent  scientist  were  directed  to 
the  perfecting  of  human  surgery,  there  is  no  doubt 
whatever  but  that  the  application  of  his  principles  to 
veterinary  surgery  has  been  productive  of  results  which, 
if  they  cannot  be  described  as  brilliant,  are  at  least  most 
striking  and  eminently  satisfactory.  For,  although  ab- 
dominal surgery  and  the  surgery  of  joints  are,  so  far 
as  the  horse  is  concerned,  as  yet  in  a  state  of  infancy, 
every  one  will  admit  that  canine  surgery  has  advanced 
by  leaps  and  bounds  since  the  principles  of  Lister  have 
been  applied  to  it.  And  even  in  the  case  of  the  horse 
we  can  justly  claim  that  marked  advance  has  been 
made  through  attention  to  Listerian  principles.  Again, 
a  knowledge  of  the  principles  of  wound  infection  has 
enabled   us   to   prevent   the   occurrence   of   those    fatal 


ANTISEPTICS— PAST  AND  PRESENT        27 

sequeUii  of  wounds,  such  as  septicemia,  pyemia,  and  ma- 
lignant edema,  which  were  formerly  so  frequently  met 
with  following  accidental  and  surgical  wounds. 

Two  factors  were  instrumental  in  the  erroneous  treat- 
ment of  wounds  that  previously  existed.  One  was  the 
lack  of  knowledge  concerning  w^ound  infection,  nothing 
being  known  with  reference  to  micro-organisms  or  their 
effects.  Another  was  the  prevalent  idea  that  heroic 
measures  were  essential  to  promote  healing ;  hence  the 
employment  of  "black  oils"  and  similar  concoctions,  in 
sublime  ignorance  of  the  deleterious  effects  of  irritants 
on  wounds,  and  of  the  existence  of  natural  means  of 
recovery. 

The  researches  of  Lister  may  be  said  to  have  extended 
from  1865  to  1890,  and  it  is  recorded  that  even  up  to 
1880  a  number  of  eminent  surgeons  were  incredulous 
as  to  the  value  of  the  antiseptic  treatment.  Hence  it  is 
not  surprising  to  find  that  in  veterinary  surgery  up  to 
this  period  the  Listerian  principles  are  not  universally 
adopted. 

It  may  truthfully  be  said  that,  as  antiseptic  treat- 
ment progressed,  from  stage  to  stage,  in  human  surgery, 
its  value  was  recognized  by  veterinary  surgeons  and  its 
principles  gradually  adopted.  The  earlier  attempts  at 
antiseptic  treatment  would  no  doubt  be  considered  crude 
in  the  present  day. 

The  Work  of  Lister 

We  read  in  the  Lancet  that  in  1865-1866  "Compound 
fractures  were  treated  by  the  local  application  of  car- 
bolic acid.  The  antiseptic  was  freely  applied  to  the 
interior  of  the  wounds  in  order  to  destroy  the  air-borne 
germs  which  had  the  property  of  causing  putrefaction. 
The  opening  in  the  integuments  was  then  covered  with 


28  WOUND  TREATMENT 

lint  charged  with  carbolic  acid,  and  protected  by  an 
external  layer  of  thin  sheet  metal.  ...  In  opening 
abscesses  a  piece  of  cloth  from  four  to  six  inches  square^ 
was  dipped  into  a  solution  of  one  part  of  crystallized 
carbolic  acid  and  four  parts  of  boiled  linseed  oil,  and 
then  laid  upon  the  skin  where  the  incision  was  to  be 
made.  One  edge  of  this  cloth  being  raised,  the  part  was 
incised  with  a  knife  previously  dipped  in  the  oil,  and  the 
cloth  was  instantly  dropped  upon  the  skin  as  an  anti- 
septic curtain,  beneath  which  the  pus  flowed  out. 

''For  the  subsequent  dressings  a  kind  of  putty  was 
made  by  mixing  common  whiting  with  the  carbolized 
oil,  and  this,  spread  into  a  layer  about  six  inches  square, 
was  laid  over  the  incision." 

From  this  simple  and  crude  beginning  evolved  those 
principles  which  were  ultimately  destined  to  revolution- 
ize surgery,  and  render  their  discoverer  the  greatest  bene- 
factor to  mankind  that  has  ever  lived.  In  1867,  carbol- 
ized shellac  plaster  was  substituted  for  the  putty  and 
found  more  convenient,  and  during  the  same  period 
ligatures  of  silk  or  catgut  were  introduced,  the  latter, 
however,  not  assuming  their  present  form  until  1881. 
Even  with  the  above  primitive  antiseptic  measures  a 
marked  improvement  resulted  in  surgical  work,  and  Lis- 
ter recorded  that  hospital  gangrene,  pyemia,  and  erysipe- 
las disappeared  from  his  wards. 

In  1869  gauze  charged  with  carbolized  resin  took  the 
place  of  the  shellac  plaster,  and  various  methods  of  em- 
ploying carbolized  oil  and  drainage  tubes  were  described 
in  articles  written  by  Lister  for  the  Lancet.  In  these 
articles  were  also  discussed  the  sterilization  and  use  of 
sponges,  and  experimental  proof  was  adduced  that  ''the 
septic  ferments  were  solid  particles  and  not  some  kind 
of  material  in  solution." 

The  use  of  boric  acid  as  an  antiseptic  was  also  de- 


ANTISEPTICS— PAST  AND  PRESENT   29 

scribed.  In  1879  improved  methods  of  protective  dress- 
ings were  introduced,  to  prevent  the  carbolic  acid  in  the 
external  dressings  from  reaching  the  wound,  once  the 
latter  had  been  rendered  aseptic  by  the  primary  appli- 
cation of  the  antiseptic.  This  protective  dressing  was 
composed  of  oiled  silk  coated  on  both  sides  with  spe- 
cially thick  copal  varnish  and  afterwards  covered  with 
a  layer  of  dextrin  to  insure  its  being  moistened  when 
dipped  into  a  watery  solution  of  carbolic  acid.  In 
cases  where  patients  showed  special  idiosyncrasies  to 
carbolic  acid,  either  salicylic  jute  or  gauze  charged  with 
a  mixture  of  one  part  of  eucalyptus  and  three  parts  of 
gum  dammar  and  paraffin,  were  employed. 

In  1881  Lister  delivered  two  addresses  containing  what 
seems  to  be  his  first  published  reference  to  pathogenic 
bacteria  as  a  distinct  class  of  micro-organisms;  and  in 
1883  he  demonstrated  the  success  of  wiring  the  patella 
when  antiseptic  principles  were  employed.  In  1884  he 
drew  attention  to  the  uses  of  corrosive  sublimate  as  a 
surgical  dressing.  He  pointed  out  in  1889  that  sal  alem- 
broth  was  untrustworthy  as  an  antiseptic,  and  in  the 
same  year  he  introduced  the  double  cyanid  of  mercury 
and  zinc  as  a  reliable  agent  with  which  to  render  gauze 
antiseptic,  but  pointed  out  that  its  germicidal  efficacy,  or 
ability  to  destroy  existing  bacteria,  was  inferior  to  its 
power  of  inhibiting  bacterial  growth;  hence  it  was  ad- 
vised that  the  dressing  should  be  moistened  with  a  five- 
per-cent  solution  of  carbolic  acid  before  being  applied. 

In  1890  Lister  announced  that  he  had  abandoned  the 
use  of  the  carbolic  spray  three  years  previously,  and 
that  he  had  substituted  a  solution  of  corrosive  sublimate 
for  carbolic  acid,  having  found  the  former  less  irritating 
and  more  efficient;  he  also  pointed  out  that  the  double 
cyanid  of  mercury  and  zinc  could  be  prepared  in  a 
perfectly  definite  manner,  and  although  the  new  prod- 


30  WOUND  TREATMENT 

net  contained  twice  as  great  a  percentage  of  cyanid 
of  mercury  as  was  present  in  the  substance  originally 
used,  it  had  no  tendency  to  cause  irritation. 

In  1907,  in  a  note  occurring  in  Sir  Hector  Cameron's 
book.  On  the  Evolution  of  Wound  Treatment  During 
the  Last  Forty  Years,  w^e  find  what  may  be  regarded 
as  the  final  utterance  of  Lister.  In  this  note  he  "advo- 
cated the  use  of  the  double  cyanid  of  mercury  and  zinc. 
He  preferred  the  use  of  sponges  for  the  absorption  of 
blood  or  other  discharges  from  an  operation  wound  to 
any  of  the  substitutes  that  w^ere  proposed,  while  for 
the  purification  and  sterilization  of  such  sponges,  with 
an  especial  view  to  the  destruction  of  both  the  spore- 
less  Micrococci  and  the  spore-bearing  tubercle  bacilli,  he 
preferred  carbolic  acid  (1  to  20)  to  any  other  germi- 
cide. For  purifying  instruments,  the  hands  of  the 
operator,  and  the  skin  of  the  patient  he  used  a  similar 
solution,  except  in  the  case  of  the  eyelids,  when  a  solu- 
tion of  corrosive  sublimate,  being  less  irritating,  was 
preferable. ' ' 

In  circumstances  where  it  was  impossible  to  exclude 
septic  agencies,  such  as  in  operations  upon  the  mouth 
or  in  putrid  sinuses,  or  in  certain  compound  fractures, 
iodoform  might  be  dusted  on  the  cut  surfaces  of  a 
w^ound  "after  mopping  with  a  solution  of  forty  grains 
of  chlorid  of  zinc  in  one  ounce  of  water."  The  useful- 
ness of  iodoform  was,  however,  rather  limited. 

In  the  external  dressing,  gauze  impregnated  with  the 
double  cyanid  of  mercury  and  zinc  was  advised,  but  be- 
fore being  applied  to  the  w^ound  this  gauze  must  be  ren- 
dered damp  with  a  solution  of  carbolic  acid. 

To  parts  where  there  w^as  very  little  space  between 
the  wound  and  some  source  of  septic  contamination, 
the  double  cyanid  powder,  mixed  with  a  sufficient  amount 
of  carbolic  solution   (1  to  20)   to  form  a  cream,  mit^'ht 


ANTISEPTICS— PAST  AND  PRESENT         31 

be  applied  with  a  camel 's-liair  brush.  In  some  circum- 
stances the  cyanic!  powder  might  possibly  be  used  as  a 
first-aid  dressing  by  dusting  it  over  wounds  by  means 
of  a  tin  with  a  perforated  top. 

"As  regards  the  changing  of  dressing,  when  there  w^as 
a  free  discharge  from  a  wound  he  preferred,  as  a  rule, 
to  remove  the  first  dressing  after  a  lapse  of  twenty-four 
hours,  but  a  longer  interval  ought  to  be  allowed  after 
certain  amputations. ' ' 

I  have  thought  fit  to  give  the  above  abridged  history 
of  the  evolution  of  antiseptic  surgery,  taken  from  the 
biography  of  the  late  Lord  Lister  that  appeared  in  the 
Lancet.  It  will  assist  in  the  consideration  of  what 
would  appear  to  be  the  two  schools  of  surgery  of  the 
present,  one  termed  the  Antiseptic,  the  other  the  Asep- 
tic ;  but,  as  will  be  seen  later  on,  the  differences  between 
them  are  more  imaginary  than  real,  so  far  as  results 
are  concerned. 

Terms  Defined 

As  already  remarked,  during  the  course  of  Lister's 
career  he  had  to  submit  to  severe  and  often  unjust  criti- 
cism, but  this  is  the  fate  of  all  who  attempt  to  leave 
the  beaten  track.  One  of  his  opponents  pointed  out  in 
1867  that  Lister  was  not  the  first  surgeon  to  use  carbolic 
acid,  but  this  was  already  admitted.  It  is  also  recorded 
that  Sir  William  Savory  (who  was  president  of  the  Royal 
College  of  Surgeons  for  five  years  in  succession,  and  full 
surgeon  at  Saint  Bartholomew's  Hospital  from  1867  to 
1891),  at  the  meeting  of  the  British  Medical  Association 
held  at  Cork  in  1879  delivered  the  address  on  "Surgery" 
and  spoke  in  attack  or  ridicule  of  the  system  of  anti- 
septic surgery.  I  introduce  this  matter  in  order  to  show 
that  surprise  should  not  be  expressed  if  examples  of 
similar  opposition  existed  among  veterinary  surgeons; 


32  WOUND  TREATMENT 

that  such  did  exist  I  have  no  doubt,  but  at  present  there 
are  few  practitioners  who  deny  the  benefits  of  Listerian 
principles. 

In  order  to  comprehend  the  principles  of  the  modern 
treatment  of  wounds,  and  to  compare  the  antiseptic 
methods  with  those  designated  as  aseptic,  it  is  necessary 
to  consider  briefly  the  significance  of  certain  terms  that 
are  employed  in  connection  with  the  subject.  Unfor- 
tunately, it  happens  that  the  same  term  is  occasionally 
applied  in  more  senses  than  one,  or  has  a  different 
meaning  attached  to  it  by  variovis  authors. 

The  term  septic  was  formerly  applied  to  Avounds  of 
an  offensive  character,  which  were  frequently  associated 
with  septicemia,  pyemia,  and  similar  conditions.  But 
as  it  is  recognized  now  that  the  above  conditions  arise 
from  the  action  of  pus-producing  organisms,  the  term 
septic  is  generally  applied  to  all  suppurating  wounds. 

Recognizing,  however,  that  wounds  may  be  offensive 
and  distinctly  unhealthy,  without  any  evidences  of  the 
presence  of  pus,  it  is  clear  that  septic  can  be  applied 
to  conditions  depending  on  a  variety  of  micro-organisms. 
In  many  cases  the  septic  condition  of  a  wound  depends 
on  one  pathogenic  organism,  but  in  almost  every  in- 
stance ordinary  pyogenic  organisms  are  present,  asso- 
ciated with  those  characteristic  of  sepsis. 

In  practice,  however,  we  are  generally  inclined  to  ap- 
ply the  term  septic  to  a  putrid  condition  of  a  wound, 
associated  or  not  with  the  presence  of  pus.  As  a  large 
number  of  accidental  wounds  in  the  horse  heal  by  granu- 
lation but  not  under  aseptic  conditions,  suppuration  to 
a  varying  extent  is  common,  but  the  pus  is  not  offensive, 
the  wound  tends  to  heal  with  ordinary  care,  and  we  do 
not  apply  the  term  septic  to  it,  although  certainly  it 
could  not  be  described  as  aseptic.  As  I  shall  point  out 
later  on,  a  large  number  of  accidental  wounds  in  horses 


ANTISEPTICS— PAST  AND  PRESENT        33 

are  already  infected  before  the  practitioner  gets  the 
chance  of  treating  them. 

Aseptic  signifies  the  absence  of  sepsis — that  is,  the 
absence  of  micro-organisms  of  any  kind.  The  term  is 
synonymous  with  ''sterile/'  or  *' germ- free. " 

Antiseptic  is  a  term  that  is  often  loosely  applied: 
literally  it  signifies  anything  opposed  to  sepsis;  in  a 
bacteriological  sense,  it  indicates  an  agent  that  retards 
or  prevents  the  development  of  bacteria,  irrespective 
of  its  power  of  destroying  their  vitality.  But  it  is 
often  erroneously  applied  as  synonymous  with  germi- 
cide, whereas  a  large  number  of  agents  classed  as  anti- 
septics are  not  capable  of  destroying  pathogenic  bacteria. 

Disinfectant  is  a  term  applied  to  an  agent  capable  of 
destroying  infective  micro-organisms,  and  so  far  as  path- 
ogenic bacteria  are  concerned  it  is  synonymous  with 
germicide.  Therefore  all  disinfectants  are  antiseptics, 
but  not  all  antiseptics  are  disinfectants. 

Deodorant  is  a  term  applied  to  substances  that  are 
capable  of  destroying  or  removing  offensive  or  unpleas- 
ant odors,  but  it  does  not  follow  that  they  possess  dis- 
infecting properties.  Many  disinfectants,  however,  are 
also  deodorants. 

Two  ''Schools"  of  Surgery 

It  will  now  be  necessary  to  devote  a  little  attention 
to  the  significance  of  the  terms  aseptic  surgery  and  anti- 
septic surgery. 

To  such  an  extent  has  the  subject  been  debated  that 
two  so-called  "schools"  have  resulted,  and  even  the 
are  not  in  agreement  as  to  the  precise  sense  in  which 
the  term  aseptic  should  be  employed.  There  is  in  fact 
a  decided  antagonism  between  these  schools  as  to  the 
teohnic  which  is  best  calculated  to  bring  about  success- 


34  WOUND  TREATMENT 

fill  results,  for  be  it  remembered  that  both  aim  at  the 
prevention  of  infection  in  wounds  and  thus  endeavor 
to  promote  healing  in  the  shortest  time  possible.  Briefly 
speaking,  the  aseptic  system  aims  at  preventing  the 
access  of  pathogenic  bacteria  to  wounds;  it  embraces  all 
the  measures  adopted  to  keep  the  wound  aseptic,  or  free 
from  the  ill  effects  of  septic  organisms,  throughout  its 
entire  course.  Antiseptics,  except  for  sterilizing  the 
patient's  skin,  the  hands  of  the  surgeon,  or  in  the 
process  of  sterilizing  ligatures,  are  rigidly  excluded, 
and  not  permitted  to  come  in  contact  with  operation 
wounds.  None  of  the  materials  used,  such  as  ligatures, 
sutures,  and  dressings,  contain  antiseptics,  but  are  simply 
sterilized.  The  instruments  are  sterilized  by  boiling, 
and  are  not  placed  in  an  antiseptic  solution. 

Of  course,  the  aseptic  method  can  be  applied  only  to 
operation  wounds  made  through  unbroken  skin  into 
non-infected  tissues.  The  disciples  of  the  aseptic  school 
term  the  methods  in  which  antiseptics  are  employed, 
either  in  solutions  or  dressings,  as  antiseptic  methods. 
Some  even  go  further  than  this,  for  we  find  one  surgeon, 
Mr.  Burghard,  stating  that  the  term  antiseptic,  when 
applied  to  the  treatment  of  wounds,  "should  be  reserved 
for  those  measures  designed  to  combat  sepsis  already 
present  in  a  wound." 

The  antiseptic  school,  however,  claim  that  their  meth- 
ods are  also  aseptic,  although  as  a  means  of  precaution 
they  employ  antiseptics  in  addition  to  the  means  of 
securing  asepsis.  Sir  Watson  Cheyne,  one  of  the  ad- 
vocates for  this  method,  states: 

'^  Aseptic  surgery  is  the  method  of  treatment  directed 
to  the  maintenance  of  an  aseptic  condition  in  the  tis- 
sues of  the  wound  presumably  existing  at  the  time  of 
operation.  .  .  .  But  on  the  other  hand,  antiseptic  sur- 
gery has  to  deal   with  tissues  which  have  already  been 


ANTISEPTICS— PAST  AND  PRESENT         35 

infe<.'tecl,  with  or  without  a  breach  of  the  surface,  and 
here  the  surgeon's  efforts  are  directed  to  diminishing 
the  effects  of  already  existing  sepsis,  or  it  may  be  in  a 
few  cases  even  to  eradicating  it." 

Mr.  Lockwood,  who  steers  a  middle  course,  says  in  his 
work  on  Aseptic  Surgery,  "Any  method  of  wound  treat- 
ment which  aims  at  sterility  wdll  be  called  aseptic." 

The  "bone  of  contention"  between  these  two  systems 
would  appear  to  be  the  question  of  the  employment  of 
antiseptics;  those  of  the  aseptic  school  holding  that 
these  agents,  by  causing  irritation,  interfere  with  the 
normal  powers  of  resistance  of  the  tissues,  and  thus  re- 
tard healing.  This  weakening  of  the  resisting  power 
of  the  tissues  may  even  enable  micro-organisms  to  enter 
and  take  eff'ect,  in  cases  where  surgical  cleanliness  was 
neglected,  although  antiseptics  were  employed. 

Sir  Watson  Cheyne,  however,  points  out  in  the  Bracl- 
sliaw  Lecture  on  the  Treatment  of  Wounds  (1908),  that 
the  Listerian  principles  in  wound  treatment  include  tw^o 
important  postulates : 

1.  Exclusion  of  bacteria  especially  of  pathogenic  organisms,  as 

far  as  possible  during  and  after  an  operation. 

2.  Avoidance  of  irritation  of  the  surface  of  a  wound,  so  as  not 

to  interfere  with  healing  or  with  the  powers  of  the  tissues, 
to  prevent  the  growth  of  any  bacteria  which  have  entered. 

This  authority  clearly  explains  that,  by  the  Listerian 
system,  every  precaution  is  taken  to  prevent  irritation 
from  the  antiseptics  employed,  and  also  states  that,  even 
with  adherence  to  the  strict  principles  of  the  so-called 
aseptic  system,  suppuration  has  occurred  when  opera- 
tions were  carried  out  in  regions  other  than  the  peri- 
toneum. He  believes  "that  of  late  many  surgeons  have 
gone  to  extremes  in  the  avoidance  of  antiseptic  solu- 
tion," and  that  the  aseptic  system,  so  called,  is  "only 
carrying  to  an  extreme  the  ])rinciple  of  avoiding  irri- 


36  WOUND  TREATMENT 

tation  of  wounds."  He  also  shows  that  even  the  appli- 
cation of  plain  boiled  water  to  the  surface  of  a  wound 
interferes  with  the  integrity  of  leukocytes  and  other 
cells,  for  under  the  microscope  they  are  found  to  swell 
up  rapidly  and  become  completely  disintegrated.  In 
summing  up  his  criticism  he  states  that  ''the  pendulum 
has  swung  too  far  in  the  direction  of  the  avoidance  of 
antiseptics,  and  that  the  reasonable  use  of  all  the  means 
at  our  disposal  for  securing  asepticity  of  wounds  will 
furnish  more  constant  results."  He  also  adds:  ''The 
chief  point  to  which  I  take  exception  is  the  employment 
of  dressings  which  do  not  contain  an  antiseptic  in  suffi- 
cient amount  to  render  the  discharges  which  flow  through 
them  unsuitable  for  the  growth  of  bacteria."  When  a 
dressing  not  containing  an  antiseptic,  although  sterile, 
becomes  soaked  with  discharge,  the  latter  may  remain 
sterile  until  it  comes  near  the  surface  of  the  dressing, 
but  then  bacteria  will  grow  into  and  rapidly  spread 
through  it  and  reach  the  wound,  unless  the  blood  has  in 
the  meantime  become  so  concentrated  by  drying  that 
it  is  no  longer  a  suitable  cultivating  medium. 

A  second  point  is  the  absence  of  antiseptic  solutions 
during  the  operation,  in  which  hands  and  instruments 
may  be  washed  from  time  to  time  to  insure  continued 
asepsis.  "The  attempt  to  treat  wounds  without  any 
antiseptics  is  a  very  unnecessary  complication.  In  the 
first  place,  it  is  ever  so  much  more  difficult  to  secure 
asepticity  of  a  wound  under  such  circumstances  than 
if  one  takes  advantage  of  antiseptics,  and  in  the  second 
place  it  requires  a  man  who  is  especially  skilled  in  bac- 
teriological work,  to  bear  in  mind  the  various  loopholes 
which  have  to  be  guarded  against  in  order  to  obtain  a 
constant  aseptic  result.  ...  I  confess  that- 1  can  see 
no  reason  for  this  great  dread  of  a  drop  of  antiseptic  ma- 
terial getting  into  a  wound ;  I  can  only  say  that  my  own 


ANTISEPTICS— PAST  AND  PRESENT        37 

results,  and  those  of  surgeons  who  use  antiseptics  judi- 
ciously, are  in  every  way  as  good  as  those  obtained  with 
the  more  elaborate  aseptic  precautions;  in  fact,  seeing 
that  we  are  not  troubled  with  sepsis  or  stitch  abscess  at 
all,  I  venture  to  assert  that  they  are  better,  because  they 
are  more  constant  and  dependable." 

Rose  and  Carless,  contrasting  aseptic  and  antiseptic 
surgery,  in  their  Manual  of  Surgery  state : 

"It  is  only  natural  that  we  who  have  had  the  privi- 
lege of  working  with  Lord  Lister,  and  have  seen  the  ex- 
cellent results  following  the  intelligent  use  of  anti- 
septics as  mapped  out  above,  should  still  cling  to  that 
line  of  practice  which  certainly  can  be  carried  out  with 
more  precision  under  all  circumstances,  both  in  private 
and  hospital,  than  the  other  plan,  the  objects  of  which 
may  at  any  moment  be  defeated  by  some  slight  inadver- 
tence or  oversight.  The  theory  of  asepsis  is  no  doubt 
perfect,  but  its  practical  application  is  often  difficult 
owing  to  the  necessity  of  having  sterilizers  always  at 
hand,  a  matter  almost  impossible  in  cases  of  emergency, 
in  private  practice." 

Measures  Attempted 

I  have  deemed  it  advisable  to  quote  the  opinions  of 
the  above  eminent  surgeons  on  the  subject  of  aseptic  and 
antiseptic  surgery  before  proceeding  to  consider  how 
far  the  principles  can  be  applied  in  veterinary  surgery. 
I  shall  endeavor  to  show  that,  although  in  the  case  of 
the  dog  it  is  possible  to  carry  out  perfect  aseptic  prin- 
ciples under  proper  surroundings,  it  is  a  far  different 
matter  when  we  come  to  deal  witli  eciuine  surgery.  T 
suppose  it  will  be  generally  admitted  that  in  the  treat- 
ment of  wounds  in  horses  there  are  certain  important 
indications  to  be  fulfilled. 


38  WOUND  TREATMENT 

IMeasures  should  be  adopted  which  are  likely  to  in- 
sure the  healing  of  wounds  in  as  short  a  time  as  possible, 
so  that  the  animal  can  return  to  work. 

Steps  should  be  taken  to  prevent  serious  complications 
such  as  septicemia,  pyemia,  malignant  edema,  erysipelas, 
bacillary  necrosis,  and  tetanus. 

Measures  for  the  prevention  of  permanent  blemishes 
are  of  importance,  and  in  the  case  of  wounds  affecting 
the  limbs,  every  effort  should  be  made  to  avoid  the  occur- 
rence of  conditions  likely  to  interfere  with  the  working 
powers  of  the  animal. 

Human  and  Veterinary   Surgery   Contrasted 

Here  it  will  be  necessary  to  compare  human  surgery 
and  veterinary  surgery  as  regards  the  treatment  of 
wounds,  both  accidental  and  as  the  result  of  opera- 
tions. The  distinguishing  features  that  stand  out 
pre-eminently  are  the  following.  The  human  surgeon 
has  the  advantage  of  a  well-equipped  hospital  with 
all  modern  conveniences,  and  a  staff'  of  trained  nurses 
to  carry  out  his  instructions.  He  is  supplied  with 
every  detail  calculated  to  insure  surgical  cleanliness 
and  to  exert  a  favorable  influence  on  the  course 
of  wounds.  ]\Ioreover,  in  operation  wounds,  aseptic  prin- 
ciples are  carried  out  from  start  to  finish  by  trained 
hands,  and  the  patients  contribute  to  favorable  results 
by  obeying  the  instructions  of  the  surgeon.  By  complete 
rest  the  healing  of  wounds  is  facilitated,  and  means  can 
be  adopted  by  which  the  affected  part  is  rendered  as  free 
from  movement  as  possible. 

In  the  case  of  accidental  Avounds,  early  treatment  is. 
carried  out  before  sepsis  has  had  time  to  exert  its  effects, 
even  though  micro-organisms  have  gained  an  entrance. 

The  veterinary  surgeon,  on  the  other  hand,  has  the  most 


ANTISEPTICS— PAST  AND  PRESENT         39 

adverse  circumstances  to  contend  Avith  in  his  endeavors 
to  render  wounds,  whether  surgical  or  accidental,  aseptic, 
and  to  keep  them  in  this  condition.  Even  in  the  best 
equipped  veterinary  infirmaries,  so  far  as  horses  are 
concerned,  it  is  extremely  difficult  to  carry  out  aseptic 
surgery.  No  doubt  by  the  use  of  iodin  it  is  now  possible 
to  sterilize  the  skin,  but  there  are  other  points  to  be  con- 
sidered. 

Given  an  operating  table,  and  a  trained  staft'  of  assist- 
ants, so  that  the  operator  is  concerned  only  with  the 
operation,  and  the  certainty  that  the  operator  or  his 
assistants  will  carry  out  the  subsequent  dressings  of  the 
wound,  then  indeed  aseptic  surgery  and  healing  by  first 
intention  are  possible,  provided  the  technic  is  carried 
out  so  that  the  entry  of  micro-organisms  is  prevented. 

Hindrances  to  Aseptic  Surgery 

But  in  ordinary  practice  a  very  different  state  of 
affairs  exists;  the  patient  is  cast  on  a  bed  of  straw, 
skilled  assistants  are  not  at  hand,  so  that  the  operator 
has  to  attend  to  the  casting,  securing,  and  so  forth, 
of  the  animal,  by  which  means  his  hands  become  con- 
taminated, and  even  the  best  directed  attempts  at  asepsis 
are  likely  to  be  frustrated  by  the  clumsy  actions  of  the 
assistants.  Then  again,  unless  the  practitioner  is  able 
to  carry  out  the  after-treatment  of  the  case,  his  primary 
endeavors  will  fail,  as  contamination  of  the  wound  is 
certain  to  occur. 

With  reference  to  accidental  wounds,  it  is  quite  ap- 
parent that  they  become  infected  before  professional 
assistance  is  sought.  Contamination  occurs  at  the  time 
the  injury  is  inflicted,  and  also  from  the  treatment 
adopted  by  the  owner  or  attendant. 

Consider  also  the  surroundings  in  which  horses  are 


40  WOUND  TREATMENT 

placed;  even  with  the  most  scrupulous  care  and  atten- 
tion, it  is  impossible  to  render  the  best  planned  stall 
free  from  micro-organisms,  and  every  act  of  the  attend- 
ant seems  calculated  to  secure  infection  of  the  wound. 
As  for  the  average  stable,  both  in  town  and  country, 
and  the  crude  methods  of  treatment  adopted  by  the 
owners  of  animals,  the  wonder  is  that  serious  or  fatal 
sequels  are  not  more  common.  For  not  only  is  the 
stall  a  veritable  breeding  ground  for  micro-organsims, 
but  also  everything  brought  in  contact  with  the  wound 
is  teeming  with  germs.  Hands  begrimed  with  dirt,  filthy 
sponges,  dirty  stable  buckets,  and  soiled  bandages  are 
much  in  evidence,  while  often  even  the  water  for  per- 
forming the  perfunctory  cleansing  of  the  wound  is  any- 
thing but  pure.  How,  then,  do  wounds  heal  under  such 
circumstances  ?  I  think  you  will  agree  that  the  explana- 
tion is  to  be  found  in  the  natural  powers  of  resistance 
possessed  by  the  horse.  If  this  vital  resistance  to  the 
action  of  micro-organisms  did  not  exist,  we  should  meet 
with  far  more  cases  of  septicemia,  pyemia,  and  similar 
conditions,  than  we  do  at  present. 

No  doubt  of  late  years  it  is  not  unusual  to  find  disin- 
fectants in  the  hands  of  many  owners  of  animals,  and 
these  agents  are  applied  to  wounds  in  concentrated  solu- 
tions with  a  total  disregard  for  ordinary  cleanliness. 
The  result  is  that  instead  of  promoting  healing  they  re- 
tard it,  as  they  exert  a  caustic  and  irritant  action  on 
the  tissues.  At  the  same  time  the  deeper  portions  of 
the  wounds  are  not  cleansed  and  abound  in  micro- 
organisms. 

A  similar  error  is  committed  with  reference  to  the  dis- 
infection of  stable  floors,  the  dirty  surface  being  allowed 
to  remain  while  disinfectants  are  scattered  thereon. 

Then  again,  while  wounds  are  being  dressed  it  is  not 
uncommon  to  find  the  dressings  laid  on  the  stable  floor 


ANTISEPTICS— PAST  AND  PRESENT        41 

for  convenience  and  thus  exposed  to  contamination  from 
several  sources. 

Varieties  of  Wound  Infection 

It  will  now  be  of  advantage  to  consider  as  briefly  as 
possible  the  measures  that  can  be  adopted  in  order  to 
fulfill  the  indications  I  have  mentioned.  In  order  to 
fully  grasp  the  importance  of  attention  to  surgical  clean- 
liness, and  the  judicious  employment  of  antiseptics  in  the 
treatment  of  wounds,  it  wall  be  necessary  to  consider  the 
micro-organisms  of  wounds,  the  modes  of  infection,  and 
the  means  by  which  these  can  be  overcome. 

With  reference  to  micro-organisms,  the  most  important 
are  the  pyogenic  cocci;  these  include  the  following 
Staphylococci  and  Streptococci : 

Staphylococcus  pyogenes  aureus  is  found  in  acute 
abscesses  and  is  responsible  for  the  majority  of  suppu- 
rative inflammations.  It  is  occasionally  present  in  gen- 
eral pyemia,  and  is  often  associated  with  other  pyogenic 
organisms  in  suppurative  processes.  It  is  very  resistant 
to  many  antiseptics,  but  is  readily  detroyed  by  solutions 
of  the  more  powerful  germicides;  it  is  very  widely  dis- 
tributed, and  is  found  abundantly  in  the  superficial 
layers  of  the  skin  of  animals  and  frequently  beneath  the 
fingernails  in  man.  Experiments  have  demonstrated  its 
power  of  producing  suppuration,  both  locally  and  inter- 
nally, and  it  has  been  shown  that  if  the  vitality  of  the 
parts  experimented  on  has  been  previously  lowered,  or 
the  tissues  damaged  by  chemical  or  mechanical  means, 
infection  occurs  more  certainly  and  readily. 

Staphylococcus  pyogenes  alhus  is  similar  to  but  far 
less  virulent  in  its  action  than  S.  aureus. 

Staphylococcus  pyogenes  citreus  is  found  only  in  ab- 
scesses. 


42  WOUND  TREATMExNT 

.  Streptococcus  pyogenes  is  another  very  important  or- 
ganism. It  is  the  causal  agent  in  spreading  cellular 
inflammation,  and  of  pyemia  and  septicemia  in  many  in- 
stances; also  of  septic  metritis,  and  ulcerative  endo- 
carditis. One  of  its  peculiarities  is  its  tendency  to  invade 
the  lymphatics  and  to  induce  lymphangitis  and  cellulitis ; 
another  is  its  capability  of  producing  acute  suppuration, 
sloughing  of  the  tissues,  and  inflammatory  wound- 
gangrene.  Probably  there  are  many  varieties  of  Strepto- 
cocci, but  their  characters  resemble  each  other  so  closely 
that  it  has  not  been  possible  to  isolate  them.  Thus  the 
S.  erysipelatis,  the  causal  agent  of  erysipelas,  resem- 
bles so  closely,  both  in  appearance  and  cultural  charac- 
ters, the  S.  pyogenes,  that  many  authorities  regard  them 
as  identical.  The  effects  produced,  however,  are  rather 
distinctive,  and  the  S.  erysipelatis  must  be  regarded  as 
an  organism  of  serious  importance  in  connection  with 
the  treatment  of  wounds. 

The  powers  of  resistance  of  Streptococci  must  be  re- 
garded as  feeble  when  compared  with  those  of 
Staphylococci. 

Bacilli  of  importance  in  connection  with  wound  infec- 
tion are  the  tetanus  bacillus,  the  hacillus  of  necrosis, 
(B.  necrophorus),  the  hacillus  of  malignant  edema,  and 
the  hacillus  coli  communis.  Occasionally  the  hacillus 
tiiherculosis  and  the  hacillus  (Pseudomonas)  pyocyaneus 
may  infect  wounds.  Among  other  causal  agents  in 
wound  infection  we  may  mention  the  Botryomyces  and 
the  Actinomyces,  also  the  Streptococcus  equi,  the  causa- 
tive factor  in  strangles  or  colt  distemper. 

With  such  a  formidable  list  of  micro-organisms  before 
us,  it  is  apparent  that  the  most  important  part  of  our 
duties  in  connection  with  the  treatment  of  wounds  is 
to  prevent  the  entrance  of  these  microbes  so  far  as  is 
possible,  or,  failing  in  this,  to  destroy  their  vitality  or 
retard  or  prevent  their  development. 


ANTISEPTICS— PAST  AND  PRESENT        43 

The  folloA\dng'  modes  of  infection  merit  consideration : 

1.  Infection  by  Air. — Aerial  infection  was  recot>nized 
even  in  prescientific  periods.  The  Listerian  principles 
and  the  carbolic  spray  were  directed  against  this  mode 
of  infection,  and  the  air  was  regarded  as  containing 
the  germs  of  pntrefaction,  which  were  capable  of  setting 
up  septic  processes  in  wounds  and  their  secretions.  This 
view  has  been  considerably  modified  in  the  present  day. 
Experiments  have  demonstrated  that  the  greater  num- 
ber of  bacteria  present  in  the  air  are  non-pathogenic, 
that  germs  exist  in  the  atmosphere  only  in  the  form  of 
dry  dust,  that  air  perfectly  freed  from  dust  is  harmless 
to  wounds,  and  when  the  air  is  kept  still,  wound  infec- 
tion rarely  takes  place  through  the  atmosphere.  But 
when  we  consider  the  surroundings  of  horses,  the  dust 
raised  from  a  straw  bed  and  during  the  process  of  clean- 
ing the  stall,  we  must  admit  the  possibility  of  infection 
by  air  containing  dust.  Indeed,  some  observers  state 
that  they  have  found  cocci  closely  related  to  the  pyogenic 
varieties,  and  sometimes  actually  belonging  to  that  class, 
in  atmosphere  dust,  especially  when  the  air  is  moist. 

2.  Infection  by  Water. — Infection  by  means  of  the 
water  used  occurs  unless  this  fluid  is  sterilized  by  boil- 
ing or  a  germicide  is  added  thereto.  Ordinary  water 
contains  a  large  number  of  bacteria,  usually  many  hun- 
dred thousand  per  cubic  centimeter. 

3.  Miscellaneous  Sources. — Other  modes  of  infection 
include  infection  from  the  skin  of  the  patient,  from  the 
hands  of  the  surgeon  or  those  of  his  assistants,  from 
instruments,  sponges  or  their  substitutes,  ligatures  and 
sutures,  dressing  materials,  vessels  or  utensils,  syringes, 
and  in  other  ways. 

Circumstances  Predisposing  to  Infection 

Among  the  factors  which  render  a  given  infection 
more  likely  to  prove  harmful  is  excessive  injury  to  the 


44  WOUND  TREATMENT 

tissues  during  an  operation,  such  as  rough  manipulation 
or  bruising  or  tearing  of  tlie  structures.  By  these  means 
the  vitality  of  the  tissues  is  lowered  and  their  resistance 
so  impaired  that  the  development  of  micro-organisms 
which  may  have  gained  entrance  is  thereby  favored.  The 
number  and  virulence  of  the  infecting  organisms,  the 
state  of  health  of  the  animal,  and  the  environment  are 
also  important  in  connection  with  this  subject. 

Wound  Healing 

Time  will  not  permit  me  to  enter  into  the  question  of 
the  repair  of  wounds.  As  you  are  well  aware,  the  modes 
of  healing  are  as  follows: 

1.  Primary  Union  or  "Union  by  First  Inten- 
tion."— This  takes  place  in  simple  incised  wounds  under 
favorable  conditions — that  is,  when  there  is  a  practical 
freedom  from  infection,  when  hemorrhage  has  been 
arrested,  and  the  surfaces  are  brought  into  apposition 
and  kept  at  rest.  It  is  the  mode  of  healing  we  will  strive 
to  bring  about  but  so  seldom  succeed  in  attaining  when 
the  horse  is  concerned. 

2.  Union  by  Granulation  and  Cicatrization. — This 
is  by  far  the  more  common  method  of  healing  in  horses. 
Formerly  there  was  an  idea  that  the  suppuration  accom- 
panying the  process  originated  from  the  superficial  layer 
of  cells  on  the  recent  granulations,  which  were  arrested 
in  their  development  and  converted  into  pus  cells,  being 
cast  off  in  the  discharge.  We  know  now  that  the  cause 
of  the  suppuration  is  the  presence  of  micro-organisms, 
and  that  union  by  granulation  can  occur  without  sup- 
puration, although  admitting  that  such  is  not  common 
in  the  horse. 

3.  Union  Under  a  Scab.— In  this,  repair  takes  place 
beneath  a  scab  formed  by  the  drying  of  the  discharges. 
This  is  cast  off  spontaneously  as  soon  as  cicatrization 


ANTISEPTICS— PAST  AND  PRESENT        45 

is  completed  underneath.    It  is  a  common  mode  of  repair 
in  wounds  left  to  heal  without  any  dressing. 

The  Technic  of  Treatment 

We  now  arrive  at  the  practical  application  of  the 
principles,  based  on  a  consideration  of  the  points  we 
have  considered.  Dealing  first  with  operation  wounds, 
in  the  case  of  healthy  tissues  in  the  normal  animal, 
there  are  certain  details  Avhich,  if  they  do  not  result 
in  bringing  about  healing  by  first  intention,  will  at  any 
rate  assist  in  the  process  of  repair,  and  prevent  the 
occurrence  of  serious  sequelae. 

I  suppose  every  one  will  agree  that  instruments  are 
best  sterilized  by  boiling  for  five  minutes  in  water  con- 
taining a  teaspoonful  of  carbonate  of  soda  to  each  pint. 
The  addition  of  the  soda  raises  the  boiling  point  of  water 
to  104  degrees  Centigrade,  and  also  prevents  the  forma- 
tion of  rust  if  the  instruments  are  left  in  the  solution  for 
some  time ;  when  required  for  use  they  are  placed  in  a 
sterilized  tray  containing  a  solution  of  carbolic  acid 
(1  to  40) .  The  water  should  be  boiling  before  the  instru- 
ments are  placed  therein,  and  the  vessel  in  which  they 
are  boiled  should  have  a  closely  fitting  lid  so  that  the 
water  will  boil  at  a  uniform  temperature.  As  regards 
sharp  instruments,  such  as  knives,  scissors,  and  needles, 
which  become  blunt  from  the  effects  of  boiling,  some 
surgeons  advise  that  the  edges  be  protected  with  a  piece 
of  gauze  or  lint,  and  state  that  blunting  does  not  then 
occur.  This  is  not  my  experience,  and  I  prefer  to  im- 
merse such  instruments  in  undiluted  carbolic  acid  for 
a  short  time,  and  then  place  them  in  a  carbolic  solution 
(1  to  20).  This  method  is  advised  by  Sir  Watson 
Cheyne,  and  it  is  also  valuable  in  case  an  instrument 
happens  to  fall  on  the  ground  during  an  operation  and 
is  immediately  required,   since  boiling  takes  five  min- 


46  WOUND  TREATMENT 

utes  to  sterilize,  Indeed,  this  method  is  also  useful  in 
emergency  operations,  when  facilities  for  boiling  are  not 
at  hand,  or  an  instrument  is  required  for  use  at  a  mo- 
ment's notice.  Corrosive  sublimate  has  a  most  destruct- 
ive effect  on  metallic  instruments,  therefore  solutions  of 
this  agent  are  unsuitable  for  sterilization  purposes. 

As  regards  the  preparation  of  the  patient's  skin  and 
the  hands  of  the  surgeon,  it  is  not  feasible  to  carry  out 
that  tedious  technic  of  sterilization  adopted  by  human 
surgeons.  Fortunately  we  have  in  tincture  of  iodin  an 
agent  which  renders  the  skin  of  the  patient  and  the  hands 
of  the  operator  aseptic.  Of  course  the  operation  area 
should  first  be  shaved  before  the  iodin  is  applied.  Two 
applications  are  necessary,  one  about  fifteen  minutes 
prior  to  operation  and  the  other  immediately  before  the 
operation.  Simple  incised  wounds  are  those  which  are 
most  likely  to  heal  by  first  intention,  provided  certain 
details  receive  attention. 

Primary  Union  Seldom  Secured 

Deeper  wounds,  as  already  remarked,  generally  heal 
by  granulation,  but  unfortunately  in  too  many  instances 
suppuration  occurs  in  spite  of  all  precautions.  But  there 
are  degrees  of  infection  depending  on  the  number,  char- 
acter, and  virulence  of  the  infecting  micro-organisms  that 
gain  entrance  to  the  wound ;  hence  the  necessity  for  sur- 
gical cleanliness  and  the  judicious  employment  of  anti- 
septics. 

There  are  two  important  points  in  connection  with  the 
subject  which  cannot  be  ignored.  The  first  is,  that  in 
operations  of  all  kinds  the  tissues  should  receive  as  little 
damage  as  possible.  Neatness  and  dexterity  in  operat- 
ing exert  a  marked  influence  on  the  healing  of  the 
resulting  wounds.  This  is  weM  exemplified  in  the  opera- 
tion of  neurectomy,  when  a  skillful  operator  exposes  the 


ANTISEPTICS— PAST  AND  PRESENT        47 

nerve  and  excises  the  desired  portion  with  little  or  no 
damage  to  the  surrounding  tissues.  On  the  other  hand, 
an  inexpert  operator,  in  his  efforts  to  expose  the  nerve, 
disorganizes  the  tissues  to  a  considerable  extent.  In 
the  former  case  the  wound  heals  by  first  intention;  in 
the  latter,  even  with  all  attempts  at  asepsis  and  antisep- 
sis, healing  occurs  by  granulation  olten  accompanied  by 
suppuration. 

The  next  point  is  with  reference  to  drainage.  Now 
in  all  wounds  of  any  extent  an  exudation  of  serum 
occurs,  generally  referred  to  as  the  ''secretions  of  the 
wound."  Such  must  not  be  allowed  to  accumulate  in 
spaces  in  the  wound,  and  proper  drainage  is  necessary. 
Accumulations  of  serum  not  only  cause  tension  in  the 
wound,  but  also  favor  the  growth  of  micro-organisms. 

The  various  details  in  connection  with  aseptic  wounds 
need  not  occupy  us  further.  For  the  reasons  already 
given,  in  the  case  of  horses  it  is  difficult  to  obtain  healing 
by  first  intention ;  that  it  is  possible  even  in  the  major 
operations  has  been  demonstrated  by  operators  who  have 
had  special  opportunities  for  carrying  out  the  technic. 
But  I  have  yet  to  learn  that  aseptic  surgery,  as  con- 
ducted by  human  surgeons,  can  be  carried  out  in  the 
ordinary  operation  by  the  general  practitioner.  Take 
even  the  latest  surgical  feat,  the  new  operation  for  ' '  roar- 
ing,"  where  aseptic  precautions  are  rigidly  carried  out 
before  and  during  the  operation,  and  what  is  the  result? 
Certainly  not  healing  by  first  intention  in  any  instance, 
and  more  often  than  otherwise  the  wound  is  septic  and 
frequently  fetid.  Such  a  condition  would  be  regarded 
as  anything  but  creditable  in  human  laryngeal  surgery — 
but  then  the  circumstances  are  different. 

There  are  some  enthusiasts  who  give  details  of  aseptic 
methods  of  castration ;  needless  to  say,  they  do  not  oper- 
ate on  many  colts  and  have  very  little  idea  of  the  condi- 


48       ..  WOUND  TREATMENT 

tions  and  environment  of  these  animals  in  the  country. 
My  experience  in  the  attempt  I  made  at  aseptic  castra- 
tion carried  out  by  means  of  ligature  was  that  no  sup- 
puration or  swelling  occurred,  but  the  animal  died  of 
septicemia  and  septic  peritonitis.  Had  suppuration  and 
swelling  occurred,,  probably  the  case  would  not  have 
resulted  fatally.  At  the  same  time  I  believe  in  all  pos- 
sible attention  to  surgical  cleanliness  and  to  antisepsis 
during  the  operation  of  castration,  although  I  know  full 
well  these  measures  will  be  frustrated  in  their  results 
by  the  owner  or  attendant  of  the  animal.  How  infec- 
tion occurs  in  castration  wounds  is  so  obvious  that  I 
need  not  refer  to  the  subject. 

Treatment  of  Accidental  Wounds 

When  operation  wounds  suppurate  or  become  septic, 
they  are  in  the  same  category  as  accidental  wounds  so 
far  as  treatment  is  concerned. 

Every  accidental  wound  may  be  assumed  to  be  in- 
fected, to  a  greater  or  less  extent. 

In  carrying  out  treatment,  there  are  certain  impor- 
tant procedures  necessary,  which  I  shall  refer  to  under 
the  following  headings : 

1.  Arrest  of  Hemorrhage. — In  order  to  be  able  to 
explore  a  wound  with  any  degree  of  accuracy,  to  say 
n(n^.ing  of  checking  preventable  waste  of  blood,  hemo- 
stasis  is  of  prime  import.  This  is  to  be  accomplished 
by  means  of  torsion  or  compression  of  all  bleeding  ves- 
sels or  by  ligation. 

2.  Cleansing  and  Disinfecting  of  the  Wound. — 
This  is  carried  out  by  careful  washing  with  an  anti- 
septic solution.  As  to  the  agent  selected  it  is  largely 
a  question  of  choice.  The  large  number  of  reliable 
germicides  that  are  now  on  the  market  render  a  selec- 
tion comparatively  easy.     Carbolic  acid  is  still  largely 


ANTISEPTICS— PAST  AND  PRESENT        49 

employed  for  the  purpose,  although  there  is  consider- 
able difference  of  opinion  as  regards  its  germicidal 
power.  Whatever  agent  is  used,  a  thorough  cleansing 
of  the  wound  is  essential. 

Unfortunately,  we  do  not  often  get  the  chance  to 
attend  to  the  first  dressing  of  a  wound,  as  the  owner 
or  the  attendant  attempts  the  process  on  the  occurrence 
of  the  accident  and  far  too  frequently  introduces  infec- 
tion. In  the  case  of  a  deep  punctured  wound,  in  which 
infection  is  probably  deep-seated,  and  the  external  open- 
ing small  in  size,  it  is  necessary  to  carefully  enlarge  the 
latter  so  as  to  carry  out  thorough  irrigation. 

3.  Removal  of  Foreign  Bodies. — This  is  a  procedure 
that  requires  special  attention.  Wounds  in  hunters  fre- 
quently contain  foreign  bodies  such  as  thorns,  portions 
of  gravel,  or  other  substances,  and  a  careful  search  is 
necessary  in  order  to  discover  their  presence ;  if  they  are 
overlooked,  serious  trouble  will  occur  afterwards. 

4.  Drainage. — Efficient  drainage  is  of  the  greatest  im- 
portance. This  is  well  exemplified  by  contrasting  the 
progress  made  by  punctured  wounds  extending  in  an  up- 
ward direction,  with  those  extending  downwards.  With- 
out proper  drainage,  all  other  means  will  fail.  To  carry 
this  out  efficiently  in  the  case  of  extensive  wounds  is  not 
always  an  easy  matter,  but  on  it  depends  success  or  fail- 
ure. Suitable  openings  must  be  made  at  dependent  parts, 
and  the  selection  of  drainage  materials  will  depend  on 
circumstances.  If  gauze  drainage  can  be  employed, 
care  should  be  taken  that  the  gauze  does  not  act  as  a 
plug  and  prevent  the  escape  of  discharge.  In  extensive 
wounds,  india-rubber  drainage  tubes  are  to  be  preferred. 
The  old-fashioned  seton  must  be  condemned,  as  it 
causes  irritation  and  increases  suppuration. 

5.  Sutures. — Careful  consideration  is  necessary  in  or- 
der to  decide  whether  it  is  advisable  to  employ  sutures. 


50  WOUND  TREATMENT 

The  frequency  with  which  extensive  wounds  involving 
the  muscular  tissues  (such  as  occur  in  the  region  of 
the  hip)  suppurate,  and  the  sutures  give  w^ay,  has  led 
some  practitioners  to  leave  such  wounds  open.  No  doubt 
in  the  case  of  a  "squealing,"  kicking  mare,  or  of  an 
unbroken  colt,  we  all  have  a  tendency  at  times  to  avoid 
the  use  of  sutures,  and  it  is  surprising  to  find  how 
readily  such  wounds  heal.  Still,  there  is  no  doubt  but 
that  less  blemish  is  left  if  the  edges  of  such  wounds 
are  brought  together  by  sutures,  at  any  rate  for  a  time, 
provided  thorough  cleansing  is  carried  out  and  proper 
drainage  provided.  In  extensive  wounds  of  this  kind 
occurring  in  vicious  animals,  I  always  cast  the  patient 
in  order  to  carry  out  the  procedure  properly.  The 
suture  material  should  be  soft  in  texture,  but  strong; 
hard  material  is  very  likely  to  cut  through  the  skin. 
In  clean-cut  wounds,  sutures  should  always  be  employed. 
It  is  hardly  necessary  to  remark  that  in  punctured 
wounds,  or  deep  wounds  of  any  kind,  and  in  the  case  of 
torn  or  lacerated  wounds  with  much  destruction  of  tis- 
sue, or  in  suppurating  or  septic  wounds,  sutures  are 
contraindicated. 

Experience  has  taught  me  that  wounds  in  the  region 
of  the  head  are  best  treated  without  sutures,  unless  such 
cases  are  in  an  infirmary  under  the  immediate  care  of 
the  practitioner,  so  that  the  early  indications  of  septic 
infection  may  be  observed.  Under  other  conditions  there 
is  a  tendency  to  the  occurrence  of  erysipelas  or  allied 
complications.  I  now  paint  such  wounds  with  tincture 
of  iodin  and  find  the  best  results  therefrom.  This  may 
be  considered  as  an  irritating  agent,  but  the  results 
justify  its  employment.  There  are  instances  of  sup- 
purating wounds  in  which  suturing  should  be  at- 
tempted in  order  to  avoid  permanent  blemish.  Some 
time  af?o  I  saw  a  case  in  a  foal  in  which  a  wound  extended 


ANTISEPTICS— PAST  AND  PRESENT    51 

from  the  commissure  of  the  lips  up  the  cheek,  exposing 
the  first  two  molar  teeth.  The  accident  had  occurred 
about  ten  days  previously,  and  two  attempts  at  suturing 
had  been  made,  but  they  were  unsuccessful.  The  wound 
was  suppurating  freely  and  granulations  had  formed 
on  each  of  the  edges,  but  there  were  no  evidences  of 
union.  My  first  attempt  was  also  unsuccessful.  I  then 
cast  the  animal  again,  removed  all  granulations  with 
sharp  scissors,  freshened  the  edges  of  the  skin  and 
mucous  membrane,  removed  all  debris  of  food,  washed 
the  parts  thoroughly  with  peroxid  of  hydrogen,  inserted 
a  deep  layer  of  sutures  so  as  to  bring  the  edges  of  the 
mucous  membrane  together,  the  sutures  being  composed 
of  soft  silk  soaked  in  peroxid  of  hydrogen,  a  superficial 
row  of  sutures  was  inserted  in  the  skin,  the  wound  was 
again  cleansed  with  the  antiseptic,  and  then  painted  over 
with  collodion.  The  foal  was  removed  from  the  dam 
and  fed  from  a  pail,  and  no  further  dressings  ordered 
except  the  application  of  compound  tincture  of  benzoin 
to  the  edges  of  the  wound  after  a  few  days.  A  few  of 
the  sutures  gave  way,  but  healing  progressed  satisfac- 
torily and  perfect  union  resulted. 

6.  Surgical  Dressings. — As  a  general  rule,  wounds 
should  be  covered  with  suitable  surgical  dressings  when- 
ever possible,  at  any  rate  in  the  earlier  stages.  Whether 
these  dressings  should  be  moist  or  dry  must  depend  on 
circumstances.  In  suppurating  wounds  I  find  the  best 
dressing,  in  cases  where  expense  is  no  object,  is  double 
C3'anid  gauze  soaked  in  a  solution  of  peroxid  of  hydro- 
gen (one  part  of  the  ten- volume  solution  to  three  of 
water).  The  gauze  is  then  enveloped  with  a  thick  layer 
of  cotton  wool  and  a  bandage. 

As  to  the  frequency  of  dressing,  this  will  depend  on 
the  amount  of  discharge.  When  the  latter  soaks  through 
the  dressing,   it  is  an  indication  for  renewal.     If  this 


52  WOUND  TREATMENT     - 

be  neglected  the  discharges  heconie  putrid  and  a  mixed 
infection  is  likely  to  occur. 

For  country  practice  a  reliable  and  cheap  antiseptic 
is  Huxley's  Liquor  Crcsolis,  in  two-per-cent  solution. 

As  the  discharge  lessens,  the  dressing  need  not  be 
changed  sooner  than  the  third  day,  and  later  on  a  dry 
antiseptic  dressing,  such  as  boric  acid  with  zinc  oxid, 
may  take  the  place  of  the  moist  one. 

In  punctured  wounds,  after  drainage  has  been  pro- 
vided for  I  find  it  is  a  good  plan  to  plug  the  wound 
with  gauze  soaked  in  peroxid  of  hydrogen.  This  dress- 
ing may  be  renewed  as  often  as  circumstances  require. 

In  country  practice  it  is  useless  to  expect  the  owner 
or  attendant  to  apply  dressings  properly.  Therefore, 
unless  there  are  reasons  to  the  contrary,  wounds  do  best 
when  left  open,  being  simply  cleansed  with  an  antiseptic 
solution  and  painted  with  compound  tincture  of  benzoin. 
This  latter  agent  fell  into  disuse  for  a  time,  but  in  my 
experience  it  is  a  most  useful  wound  dressing  for  coun- 
try cases,  where  as  little  handling  of  the  wound  as  pos- 
sible is  an  important  matter. 

Carbolized  oil,  which  at  one  time  was  so  popular  a 
dressing,  is  now  known  to  be  absolutely  inert  as  a 
germicide. 

In  hunters,  deep  puncture  wounds  of  the  front  of 
the  hind  fetlock  due  to  sharp  stones  are  of  frequent 
occurrence.  The  bursa  of  the  tendon  may,  or  may  not, 
be  opened,  but  acute  inflammation  rapidly  develops  and 
marked  pain  is  present.  Attempts  to  heal  such  wounds 
quickly  do  not  prove  successful,  as  infection  is  deeply 
situated;  in  my  experience  the  best  dressing  is  one  of 
the  modern  substitutes  for  poultices,  which  are  com- 
posed of  kaolin,  glycerin,  and  antiseptic  agents,  applied 
hot  and  changed  daily.  When  acute  symptoms  have 
subsided,  the  ordinary  dressings  may  be  applied. 


ANTISEPTICS— PAST  AND  PRESENT    53 

Wounds  of  the  sheaths  of  the  flexor  tendons  are  often 
serious  in  consequence  of  the  infection  extending  up- 
ward and  downward.  Free  drainage  should  be  provided 
early,  and  rigid  attention  to  antisepsis  is  necessary. 

In  all  wounds  in  the  region  of  the  limbs  there  is  a 
tendency  to  the  formation  of  exuberant  granulations. 
These  require  early  attention  in  order  to  avoid  perma- 
nent blemishes.  I  find  that  the  judicious  application 
of  finely  powdered  sulphate  of  copper  is  the  most  reliable 
treatment  in  these  cases,  old  fashioned  no  doubt,  but 
efficient  for  the  purpose  required. 

Wounds  of  the  knee,  involving  the  extensor  tendons 
in  the  vicinity  of  this  joint,  are  not  uncommonly  followed 
by  fibrous  ankylosis,  accelerated  no  doubt  by  keeping  the 
horse  from  lying  down.  When  such  a  complication 
occurs,  the  animal  should  be  cast  and  chloroformed  and 
the  joint  forcibly  flexed,  otherwise  the  horse  will  be 
useless. 

Wounds  in  the  feet  due  to  picked-up  nails  I  shall  not 
consider  here,  as  this  would  form  a  separate  subject  for 
a  paper.  But  in  hunters,  wounds  are  not  uncommon 
in  this  region  as  the  result  of  portions  of  furze  (gorse) 
branches  entering  the  foot  in  the  vicinity  of  the  frog. 
Sharp  portions  of  flint  not  uncommonly  enter  the  foot 
and  extend  deep  into  the  sole.  The  detection  of  such 
foreign  bodies  is  not  always  an  easy  matter  and  requires 
a  careful  examination  of  the  foot.  I  believe  the  best 
treatment,  after  the  removal  of  the  foreign  body  and 
the  proper  enlargement  of  the  wound,  is  to  apply  pure 
carbolic  acid  or  lysol,  and  a  cataplasm  composed  of 
kaolin  and  glycerin. 

In  my  experience  the  most  dangerous  wounds  are 
those  due  to  punctures  from  shafts,  such  as  result  from 
collisions.  The  difficulty  in  obtaining  drainage  is  very 
considerable,  especially  when  the  wound  occurs  in  the 


54  WOUND  TREATMENT 

region  of  the  hind  quarter.  But  proper  drainage  must 
be  secured  at  all  costs,  otherwise  treatment  will  fail  and 
septicemia  result.  If  necessary,  the  animal  should  be 
cast  in  order  to  carry  out  the  surgical  procedure ;  after- 
treatment  will  consist  in  copious  irrigation  with  anti- 
septic solutions  carried  out  by  means  of  a  Winton's 
syringe  provided  with  a  gum-elastic  top.  "Where  ex- 
pense is  not  objected  to,  the  wound  should  be  plugged 
with  double  cyanid  gauze  soaked  in  hydrogen  peroxid 
solution,  the  irrigation  and  dressing  being  carried  out 
daily. 

Time  will  not  permit  me  to  deal  with  the  question  of 
open  joints,  which  in  reality  woul4  require  a  special 
paper.  But  I  cannot  omit  drawing  attention  to  the 
dangerous  character  of  punctured  wounds  in  the  fore- 
arm, which  are  not  uncommonly  followed  by  purulent 
arthritis  of  the  elbow  joint.  The  septic  inflammation  ex- 
tends along  the  sheaths  of  the  tendons,  and  these  ten- 
dons support  directly  the  synovial  membrane  of  the 
elbow  joint.  Hence  wounds  of  this  region  should  be 
drained  as  early  as  possible  by  a  free  dependent  opening. 

Conclusion 

The  practical  outcome  of  a  consideration  of  the  sub- 
ject appears  to  be  that,  although  we  can  never  hope  to 
practice  aseptic  surgery  in  the  strict  sense  of  the  term, 
we  can  at  least  carry  out  antiseptic  principles,  so  far  as 
is  possible  under  the  very  unfavorable  conditions  that 
surround  us. 

Improvements  in  the  results  obtained  are  more  likely 
to  follow  strict  attention  to  surgical  cleanliness  and 
proper  drainage  of  wounds  than  care  in  the  selection 
of  the  agents  we  employ  as  drainage.  After  twenty-five 
years  of  ''playing  the  game,"  and  seeing  it  played  by 


ANTISEPTICS— PAST  AND  PRESENT        55 

others,  I  cannot  believe  that  among  the  host  of  agents 
that  are  introduced  yearly,  one  possesses  any  special 
virtues  over  another  so  far  as  the  healing  of  wounds  is 
concerned. 

In  conclusion,  I  think  the  practical  deduction  to  be 
drawn  is  that  everv  attempt  should  be  made  to  exclude 
infection  from  wounds,  whenever  this  is  possible,  and, 
in  the  case  of  wounds  already  infected,  to  retard  the 
growth  and  development  of  micro-organisms  by  the  judi- 
cious employment  of  antiseptics. 

But  whether  in  the  case  of  operation  or  of  accidental 
wounds,  it  is  quite  apparent  that  in  ordinary  practice 
we  cannot  dispense  with  antiseptics,  and  attempts  to 
do  so  are  likely  to  be  followed  by  disaster. 


SUPPRESSION  OF  HEMORRHAGE 

By  E.  WALLIS  HOARE,  F.R.C.V.S.,  Cork,  Ireland 

The  arrest  of  hemorrhage  is  one  of  the  most  important 
points  in  connection  with  the  technic  for  the  treatment 
of  both  surgical  and  accidental  wounds.  There  are  two 
reasons  why  hemorrhage  should  be  controlled: 

1.  To  prevent  a  fatal  termination  from  excessive  loss  of  blood. 

2.  Hemorrhage  lowers  the  vitality  of  the  animal's  system  and 

hence  retards  the  healing  of  wounds.     Also  blood  clots  in  a 
wound  form  a  nidus  for  the  development  of  micro-organisms. 

Fatal  hemorrhage,  so  far  as  wounds  are  concerned, 
occurs  when  a  large  blood  vessel  is  severed  and  profes- 
sional assistance  is  not  at  hand.  But  it  may  result,  in 
spite  of  the  efforts  of  the  practitioner,  when  one  or 
more  large  vessels  are  severed  that  are  so  deeply  situ- 
ated they  cannot  be  li gated.  This  may  occur  in  the 
case  of  extensive  wounds  due  to  the  penetration  of  a 
shaft  between  the  forearm  and  the  chest,  or  at  any  part 
of  the  pectoral  region,  or  in  the  vicinity  of  the  inferior 
aspect  of  the  neck. 

In  such  cases  but  little  time  is  allowed  for  the  effort- 
of  the  surgeon  to  prove  successful.  Very  often  more 
than  one  vessel  is  severed,  and  unless  ligation  can  be 
employed  without  delay,  a  fatal  termination  will  result. 
Plugging  the  wound  with  tow  is  of  little  or  no  use  when 
the  hemorrhage  proceeds  from  a  large  vessel.  In  my 
experience  the  only  plan  that  offers  any  chance  of  suc- 
cess is  to  insert  a  temporary  plug  of  tow  and  to  cast 
the  animal  immediately,  then  seek  for  the  bleeding  vessel 

57 


58  WOUND  TREATMENT 

(enlarging  the  wound  if  necessary),  and,  having  secured 
it  with  an  artery  forceps,  apply  a  ligature.  In  some 
instances  it  may  not  be  necessary  to  cast  the  horse,  as  in 
consequence  of  the  loss  of  blood  he  does  not  resist  the 
necessary  manipulation,  but  the  procedure  is  far  more 
easily  and  satisfactorily  carried  out  when  the  animal  is  in 
the  recumbent  position. 

As  already  remarked,  all  our  efforts  may  fail  in  cases 
where  the  vessel  is  out  of  reach.  Plugging  with  tow  may 
succeed  when  the  wounded  vessel  is  not  of  large  size, 
but  even  in  this  case  it  is  not  to  be  advised.  Although 
such  plugging  may  temporarily  arrest  the  hemorrhage, 
there  is  always  the  risk  that  secondary  bleeding  will 
occur  and  prove  fatal  in  the  absence  of  the  attendant. 
It  may  be  laid  down  as  a  rule  that  ligature  is  the  only 
safe  method  to  adopt  in  the  suppression  of  hemorrhage. 
Only  when  the  vessel  cannot  be  secured  should  resort  be 
had  to  plugging  the  wound. 

It  sometimes  happens  that  although  a  vessel  may  be 
secured  by  the  artery  forceps,  in  consequence  of  its  depth 
a  ligature  cannot  be  applied.  In  many  instances,  by 
the  employment  of  Schoemaker's  pattern  of  forceps,  in 
which  by  means  of  a  groove  at  the  point  of  one  of  the 
blades  a  ligature  is  held  in  position,  a  deep-seated  vessel 
may  be  ligated.  This  is  a  most  useful  instrument  and 
should  be  in  the  possession  of  every  practitioner. 

I  have  frequently  left  an  artery  forceps  m  situ  for 
twenty-four  hours  in  cases  where  a  ligature  could  not 
be  applied.  Care  should  be  taken  to  tie  up  the  animal 
during  the  interval  so  that  he  may  not  lie  down  and  so 
cause  the  instrument  to  become  detached,  or  to  be  driven 
inward  by  pressure. 

In  preparing  for  major  operations,  a  plentiful  supply 
of  artery  forceps  of  large  and  small  sizes  should  be 
provided,  as  one  never  knows  when  a  large  vessel  may 


SUPPRESSION  OF   HEMORRHAGE  59 

be  severed.  There  are  so  many  patterns  of  these  instru- 
ments now  on  the  market  that  a  selection  of  the  best 
is  not  an  easy  matter.  Personally,  I  prefer  the  pattern 
known  as  the  Mayo-Oehner,  which  is  of  the  ''rat's- 
tooth"  type  and  very  efficient.  For  ease  in  getting  the 
ligature  to  slip  down  the  forceps,  Greig-Smith's  pattern 
can  be  recommended,  and  the  larger  sizes  are  especially 
useful  for  ligating  large  vessels. 

As  to  the  ligature  material,  some  prefer  silk,  others 
catgut,  but  I  prefer  the  material  known  as  "Chinese 
twist,"  which  can  be  obtained  in  all  sizes,  can  be  readily 
sterilized,  and  stands  great  strain.  Nothing  is  more  an- 
noying when  ligating  a  vessel  than  to  have  the  ligature 
material  break  at  a  critical  moment. 

In  the  case  of  small  vessels,  where  no  ligature  is  re- 
quired, I  have  found  that  Blunk's  hemostatic  forceps 
are  convenient  and  reliable. 

Tumors 

There  are  certain  operations  in  which  the  question  of 
the  arrest  or  control  of  hemorrhage  is  of  special  im- 
portance. Tumors  in  the  region  of  the  shoulder,  also 
known  as  ''collar"  tumors,  in  some  cases  depending  on 
the  presence  of  Botryomyces  but  in  others  having  a 
doubtful  etiology,  need  special  care. 

When  ordinary  treatment  fails — that  is,  locating  the 
abscess  by  means  of  a  trocar  and  cannula,  free  incision, 
curetting  the  cavity,  and  plugging  with  tow  soaked  in 
tincture   of  iodin — then  excision  must  be   resorted   to. 

A  knowledge  of  the  anatomy  of  this  region,  and  of 
the  firm  consistency  of  the  tumor  and  its  extensive 
attachments,  indicates  that  serious  hemorrhage  is  likely 
to  cceur  unless  care  be  taken  in  the  teclinic  of  the  opera- 
tion. The  position  of  the  carotid  artery  should  be 
carefully  noted,  so  as  to  avoid  injuring  this  vessel.  But 
in  my  experience  the  vessel  which  is  most  likely  to  be 


60  WOUND  TREATMENT 

severed  is  the  ascending  branch  of  the  inferior  cervical 
artery.  In  many  instances  I  have  located  and  ligatured 
this  vessel  prior  to  incising  the  parts  in  the  vicinity  and 
thus  saved  much  subsequent  trouble  and  time.  And 
here  I  may  remark  that  in  every  instance  and  in  every 
region  when  we  come  across  a  vessel  that  is  likely  to  be 
severed  during  the  operation,  it  is  a  good  plan  to  ligature 
it  before  proceeding  further. 

Large  pressure  forceps  are  useful  to  hold  deep-seated 
portions  of  the  tumor.  The  growth  is  severed  along 
the  edge  of  the  forceps,  and  any  vessels  that  are  cut  can 
be  seen  and  readily  secured  before  the  structures  are 
let  go. 

After  the  tumor  has  been  removed,  and  all  bleeding 
points  secured,  I  advise  packing  with  carbolized  tow  in 
order  to  combat  any  danger  of  secondary  hemorrhage. 
Healing  by  first  intention  is  not  to  be  expected,  and  the 
packing  can  be  removed  wdthin  twenty-four  hours.  I 
have  met  with  very  serious  secondary  hemorrhage  from 
cases  of  this  kind,  and  hence  I  find  that  firm  packing 
immediately  after  operation  is  the  best  plan  to  adopt. 

When  secondary  hemorrhage  does  occur,  it  is  very 
difficult  to  suppress;  these  tumors  have  such  extensive 
vascular  attachments  that  bleeding  may  be  very  profuse, 
and  when  it  occurs  at  night  time,  and  is  not  immediately 
observed  and  checked,  a  fatal  result  may  ensue.  In  the 
case  of  a  quiet  animal,  the  bleeding  vessel  may  be  located 
and  secured,  but  otherwise  it  may  be  necessary  to  cast 
the  patient  in  order  to  carry  out  the  necessary  pro- 
cedure. 

In  less  severe  cases,  firm  plugging  with  tow  and  deep 
suturing  of  the  edge  of  the  w^ound  will  prove  successful. 
In  the  case  of  all  wounds  the  great  objection  to  firm 
plugging  is  the  extensive  swelling  that  usually  results, 
therefore  I  always  prefer,  when  possible,  to  secure  the 


SUPPRESSION  OF  HEMOERHAGE  61 

l>leeding  vessel.  Moreover,  there  are  instances  in  which 
the  hemorrhage  recurs  after  the  packing  is  removed,  and 
as  a  result  the  cleansing  of  the  wound  cannot  be  properly 
carried  out. 

Castration 

Why  hemorrhage  occurs  in  some  cases  after  castration 
and  not  in  others,  when  the  measures  adopted  to  secure 
the  spermatic  artery  are  similar  in  each  instance,  is  a 
problem  which  is  not  easy  to  solve. 

Generally  speaking,  the  most  serious  and  annoying 
cases  are  those  that  occur  some  time  after  the  operation, 
say  within  twelve  or  twenty-four  hours.  As  my  experi- 
ence of  castration  cases  is  limited  to  those  operated  on 
by  torsion,  I  can  deal  with  the  subject  onl}'  from  this 
point  of  view.  This  experience  has  taught  me  that  in 
the  vast  majority  of  cases,  if  torsion  is  properly  carried 
out  and  the  spermatic  artery  is  in  a  healthy  condition 
and  the  animal  healthy,  hemorrhage  does  not  occur. 
The  exceptions  are  those  cases  in  which  we  cannot  account 
for  the  hemorrhage. 

The  procedure  to  be  adopted  depends  on  the  extent 
of  the  bleeding.  We  frequently  observe  cases  that  bleed 
profusely  after  getting  up,  but  this  soon  ceases  without 
any  treatment.  Obviously,  such  do  not  depend  on  hemor- 
rhage from  the  spermatic  artery,  but  the  bleeding  arises 
frcm  the  artery  of  the  cord  or  from  a  vessel  in  the 
scrotum. 

When  the  hemorrhage  is  profuse  and  clearly  arterial, 
the  best  plan  is  to  cast  the  animal,  seek  for  and  secure 
the  severed  end  of  the  spermatic  cord,  and  apply  a  liga- 
ture. This  is  far  preferable  to  plugging  the  inguinal 
canal  and  scrotal  cavity  with  tow,  with  its  risks  of  sec- 
ondary hemorrhage  when  the  packing  is  being  removed, 
and  the  extensive  swelling  which  always  results.    In  the 


62  WOUND  TREATMENT 

case  of  secondary  hemorrhage  occurring  at  night,  plug- 
ging with  tow  may  be  the  only  practicable  measure  to 
be  adopted  under  the  circumstances. 

In  the  after-treatment  care  should  be  taken  to  remove 
all  blood  clots,  for  otherwise  a  septic  condition  is  likely 
to  result.  It  must  be  admitted  that  in  many  cases  the 
hemorrhage  after  castration  ceases  spontaneously.  The 
measures  adopted,  such  as  throwing  cold  water  over  the 
loins  or  applying  cloths  soaked  in  cold  water  to  the  same 
region,  are  of  doubtful  efficacy. 

That  ''weedy"  debilitated  colts  are  most  subject  to  this 
variety  of  hemorrhage  is  well  known.  Again,  aged  don- 
keys and  mules  are  very  apt  to  bleed  profusely  unless 
special  care  is  taken  in  the  performance  of  torsion  of 
the  artery. 

I  have  often  observed  that  castration  performed  under 
deep  chloroform  anesthesia  is  likely  to  be  followed  by 
hemorrhage  some  hours  afterwards.  This  does  not  occur 
when  a  lighter  degree  of  anesthesia  is  employed. 

Epistaxis 

Hemorrhage  from  the  nose  occasionally  gives  rise  to 
considerable  trouble,  especially  when  arising  from  in- 
juries about  the  facial  and  nasal  region.  As  it  is  dan- 
gerous to  plug  both  nasal  passages  of  the  horse,  this 
method  of  suppressing  the  hemorrhage  is  not  practi- 
cable. If  one  nasal  passage  only  be  plugged,  the  blood 
finds  its  way  down  the  other. 

Local  injection  of  adrenalin  proves  useful,  and  rais- 
ing the  horse's  head  will  also  assist  in  controlling  the 
hemorrhage,  but  care  must  be  taken  lest  the  blood  gain 
entrance  to  the  trachea. 

Accidental  Wounds 

I  have  already  referred  to  the  question  of  hemorrhage 
arising  from  injuries  due  to  shafts  penetrating  the  body. 


SUPPRESSION  OF  HEMORRHAGE  63 

But  there  are  many  minor  injuries  in  which  hemorrhage 
may  be  a  troablesome  feature.  Wounds  received  during 
hunting  furnish  a  large  number  of  cases  in  sporting 
districts.  In  these  the  same  golden  rule  applies:  always 
secure  and  ligature  a  dleeding  vessel  whenever  possible. 
Avoid  plugging  and  tight  bandaging  except  as  an  emer- 
gency measure. 

As  regards  hemostatic  agents,  they  have  no  effect  in 
the  case  of  vessels  of  any  size,  and  the  majority  of  them 
irritate  the  wound. 

Deep  punctured  wounds,  in  which  it  is  not  possible 
to  secure  a  bleeding  vessel  without  making  an  extensive 
opening,  may  be  plugged  with  antiseptic  gauze. 

Wounds  involving  the  digital  arteries  in  the  region  of 
the  coronet  are  often  troublesome,  as  it  is  by  no  means 
easy  to  secure  the  bleeding  vessel,  especially  in  the  case 
of  a  nervous,  excitable  horse.  The  Mayo-Ochner  artery 
forceps  will  be  found  useful  for  cases  of  this  kind. 

When  an  artery  or  vein  is  exposed  in  an  extensive 
wound,  but  not  severed,  it  is  advisable  to  apply  a  liga- 
ture, since  the  walls  of  the  vessel  may  give  way  and 
serious  hemorrhage  result.  Should  it  become  necessary 
to  apply  a  ligature  to  the  carotid  artery  it  must  be 
remembered  that  in  consequence  of  the  collateral  circu- 
lation both  the  proximal  and  the  distal  ends  of  the 
vessel  must  be  secured. 

As  regards  the  employment  of  the  actual  cautery  as 
a  hemostatic  agent,  in  consequence  of  tissues  it  pro- 
duces it  is  now  being  discarded.  In  Great  Britain  it  is 
still  employed  by  some  practitioners  in  the  operation  of 
castration  and  also  docking.  From  a  humane  and  scien- 
tific point  of  view  it  is  to  be  hoped  that  the  suppression 
of  hemorrhage  by  means  of  the  actual  cautery  will  soon 
be  regarded  as  one  of  the  relics  of  the  barbarous  ages. 


TREATMENT  OF  WOUNDS 

By  L.  A.  MERILLAT 

The  treatment  of  wounds!  What  a  vast  subject  I 
When  the  surgeon  makes  a  wound,  or  meets  one  acci- 
dentallv  inflicted,  he  is  immediately  confronted  with 
the  important  task  of  guiding  the  reparative  process 
through  and  to  the  successful  issue  that  will  not  only 
protect  the  patient  against  serious  complications,  but 
which  will  also  leave  the  once  injured  body  in  the  best 
possible  condition :  sound,  healthy,  and  unblemished.  The 
word  •'guiding''  is  used  advisedly,  because  the  first  rule 
to  lay  down  in  the  management  of  wounds  is  that  wound 
healing  is  a  process  of  nature  that  can  be  guided — 
influenced,  but  not  forced.  The  surgeon  does  not  heal 
a  wound;  he  merely  puts  it  and  keeps  it  in  a  favorable 
condition  to  heal.  The  inherent,  mysterious,  subtle, 
cellular  activity  that  begins  as  soon  as  a  wound  is  in- 
flicted and  ends  in  strict  obedience  to  an  inexplicable 
law  as  soon  as  the  breach  is  filled  up  with  just  enough 
new  tissue  to  level  off  the  excavation,  is  indeed  a  process 
to  be  guided  rather  than  forced  by  any  outer  inter- 
ference. 

The  student  of  wound  healing  who  first  of  all  learns 
the  wisdom  of  non-interference  with  this  process  has 
already  laid  down  a  good  foundation  for  wound  treat- 
ment. In  other  words,  he  who  bases  his  management 
of  wounds  upon  the  fact  that  the  new  tissue  that 
sprouts  out  from  the  walls  of  a  traimiatic  cavity  under 
normal  conditions  grows  safely  to  a  useful,  mature 
tissue   without   outside  help,   is   the   successful   healer, 

65 


66  WOUND  TREATMENT 

while  on  the  other  hand  he  who  is  bent  upon  constant 
meddlesome  interference  with  the  germination,  growth, 
and  maturing  of  the  reparative  elements  required  to  re- 
store the  lost  elements,  invites  complications,  retards 
the  normal  activity  of  tissue  construction,  and  usually 
leaves  indelible  blemishes  as  evidence  of  his  harmful 
practices. 

The  system  of  wound  treatment  in  general  use  in  the 
veterinary  profession,  to  be  perfectly  frank,  does  not 
entitle  us  to  much  credit.  Our  therapy  in  this  connec- 
tion is  severely  lacking  in  the  refinement  that  enables 
the  surgeon  of  human  beings  to  make  and  manage  suc- 
cessfully .  enormously  large  wounds.  The  reader  may 
here  insist  that  he  has  obtained  good  results  from  his 
wound  treatment.  But  is  this  really  the  fact?  Is  it  not 
more  nearly  the  truth  that  our  successfully  treated 
wounds  are,  after  all,  trivial  wounds,  and  that  our  really 
serious  wounds,  surgical  or  accidental,  are  too  often 
fatal,  or  that  they  permanently  disfigure  or  perma- 
nently disable  our  animal  patients?  And  is  it  not 
still  a  painful  fact  that  the  whole  veterinary  profes- 
sion continues  to  exhibit  a  real  fear  of  extensive  sur- 
gical wounds  because  of  their  bad  behavior?  And  is  it 
not  still  the  truth  that  many  of  us  fear  to  invade  the 
splanchnic  cavities  and  synovials,  believing  that  acci- 
dental wounds  of  these  cavities  are  fatal  and  surgical 
wounds  very  hazardous?  Such  an  impression  should 
no  longer  prevail  among  us,  at  least  not  to  the  same 
extent  as  in  years  gone  by.  With  our  knowledge  of 
regeneration  on  the  one  hand,  and  of  the  pathology  of 
wound  complications  on  the  other,  we  should  approach 
almost  any  wound  with  more  confidence  than  formerly; 
and  then  by  planning  various  schemes  to  remove  every 
harmful  element,  inherent  and  ulterior,  a  very  remark- 
able success  may  be  achieved  in  the  treatment  of  even 


TREATMENT  OF  WOUNDS  67 

very  serious  wounds.  It  must  be  borne  in  mind  first 
of  all  that  the  wounds  we  meet  and  make,  and  the 
nature  of  our  animal  patients,  call  for  special  systems 
of  management  from  the  beginning  to  the  end  of  the 
healing  period.  After  we  have  followed  the  general 
principles  which  should  govern  the  management  of 
wounds  of  all  living  creatures,  there  are  still  special 
plans,  systems,  methods,  and  procedures  applicable  to 
our  patients  which  must  be  executed  in  order  to  meet 
the  requirements  needed  to  obtain  the  best  results. 

The  necessity  for  skillful,  scientific,  ingenious  wound 
treatment  is  estimated  best  by  those  who  venture  into 
the  field  of  major  surgery.  Just  so  long  as  the  surgeon 
restricts  his  enterprises  to  minor  procedures,  the  refine- 
ment of  technic  required  to  succeed  in  major  work  is  not 
appreciated,  as  the  minor  wound  heals  in  spite  of  the 
method,  while  the  major  wound  ends  fatally  or  in  some 
other  disaster.  In  short,  if  we  desire  to  go  onward 
with  our  animal  surgery  we  must  first  surmount  the 
various  obstacles  due  to  the  fact  that  our  patients  be- 
longing to  the  brute  creation  are  unable  to  give  the 
surgeon  any  help,  are  barely  worth  the  expense  of 
much  surgical  work,  and  are  always  dirty  and  are 
always  kept  in  dirty  surroundings.  To  do  good  surgical 
work  even  with  these  obstacles  working  against  us,  is 
our  task,  and  it  is  a  task  we  must  in  some  way  master. 
We  are  no  longer  compelled  to  sing  the  praises  of 
aseptic  work;  everybody  now  recognizes  its  merit,  no 
one  but  the  very  ignorant  ignores  it ;  and  as  I  once  heard 
a  medical  bystander  remark:  "Even  the  horse  doctor 
practices  it."  Ten  years  ago  we  were  frantically  de- 
fending asepsis  for  animal  surgery  as  a  more  or  less 
practical  procedure;  to-day  everybody  knows  it  can  be 
successfully  practiced  through  almost  every  surgical 
operation  and  through  the  postoperative  convalescence. 


68  WOUND  TREATMENT 

Wound  infections  of  the  surgeon's  making,  once  the 
rule,  are  fast  becoming  the  exception. 

During  the  last  two  decades  the  veterinarian  has, 
of  course,  learned  much,  with  the  rest  of  mankind,  about 
the  nature  and  behavior  of  wound  infections,  and  espe- 
cially about  the  manner  wound  infections  are  carried 
into  wounds.  We  have  been  painfully  slow  to  acknowl- 
edge the  venomous  nature  of  our  hands  and  instruments, 
in  ^ur  well-rooted  belief  that  microbes  around  a  sur- 
gical operation  on  animals  were  so  abundant  and  so 
volatile  that  no  system  of  procedure  could  cope  with 
them.  With  all  of  these  prejudices  out  of  the  way,  and 
with  every  one  satisfied  that  the  animal  surgeon  may 
now,  if  he  chooses,  protect  his  patients  against  these 
self-made  infections,  our  attention  must  be  directed  also 
toward  other  obstacles.  What  these  are  and  how  we 
may  attempt  to  meet  them  will  be  considered  in  the 
succeeding  paragraphs.  The  object  of  this  article  is 
more  to  bring  the  modern  conception  of  wound  treat- 
ment before  the  profession  in  the  hope  that  a  better 
system  of  wound  treatment  applicable  to  animals  may 
be  adopted  in  the  veterinary  profession  to  the  decided 
benefit  of  our  onward  march  toward  higher  levels ;  pre- 
cisely as  a  few  years  ago  it  was  found  necessary  to 
preach  the  gospel  of  asepsis.  That  these  obstacles  are 
formidable,  and  the  recommendations  I  may  be  able  to 
make  inadequate,   is  hereby  acknowledged. 

The  treatment  of  wounds!  Let  us  understand  one 
another.  What  to  rub  on  a  wound  or  what  not  to  rub 
on  a  wound  is  not  in  our  mind  in  this  discussion.  On 
the  contrary,  we  are  taking  the  treatment  of  wounds 
in  its  fullest  sense,  ' '  The  curing  of  the  patient  by  the 
surgeon,"  for  this  is  what  wound  treatment  is,  after 
all.  In  surgery  the  healing  of  the  wound  is  usually 
analogous  to  curing  the  patient.    It  is  evident,  therefore, 


TREATMENT  OF  WOUNDS  69 

that  wound  treatment  begins  in  the  preoperative  de- 
liberations over  a  proposed  surgical  subject,  for  if  the 
wound  will  not  heal,  no  operation  is  indicated. 

Preoperative  Treatment  of  Wounds 

Under  this  somewhat  irrelevant  title  is  included  a 
consideration  of  those  systematic  conditions  which  miti- 
gate against  the  healing  of  wounds  made  by  the  sur- 
geon and  those  accidentally  inflicted;  the  influence  the 
general  health  will  have  upon  the  behavior  of  a  pro- 
posed surgical  wound;  the  condition  under  which  the 
patient  must  live  during  healing ;  and  the  amount  of 
intelligent  after-care  it  will  be  possible  to  administer. 

The  bearing  of  the  health  and  especially  the  vigor  of 
a  wounded  patient  upon  the  healing  of  a  wound  has 
too  often  been  ignored.  In  a  large  city,  where  horses 
are  often  reduced  to  a  pronouncd  state  of  general  en- 
feeblement  from  hard  work,  or  from  hard  work  and  pri- 
vation combined,  the  influence  of  this  element  in, .the 
behavior  of  wounds  is  most  appreciated.  The  serious 
nail  prick,  implicating  the  pedal  synovials,  for  example, 
will  respond  to  active  treatment  in  the  vigorous  subject, 
but  will  prove  fatal  in  the  weak.  In  the  strong,  wounds 
are  inclined  to  have  only  a  local  effect,  while  in  the 
weak,  bacteria  and  their  metabolic  products  are  almost 
certain  to  tend  to  generalize  and  cause  such  grave  com- 
plications as  septicemia,  pyemia,  and  embolic  pneumonia. 

The  management  of  wounds  must,  therefore,  begin  in 
the  preoperative  deliberations.  We  must  know  first  if 
the  patient  is  fit  to  withstand  a  given  ordeal,  and  then 
plan  accordingly.  I  know  of  no  one  element  that  works 
so  much  harm  in  animal  surgery  as  that  of  operating 
upon  the  weak  subject.  Whether  the  enfeeblement  is 
due  to  disease  or  other  influences  does  not  matter,  the 


70  WOUND  TREATMENT 

relations  between  the  patient's  condition  and  the  trau- 
matism is  of  equal  importance. 

The  point  may  be  illustrated  in  fistula  of  the  withers. 
In  a  young,  vigorous  subject  with  a  fistula  of  recent 
origin,  before  or  soon  after  the  first  abscess  has  dis- 
charged its  contents  the  surgeon  may  proceed  fearlessly 
to  the  most  radical  steps,  with  a  full  assurance  of  a 
rapid  recovery.  The  trauma  may  be  large  enough  to 
cause  considerable  shock,  and  the  blood  loss  may  be  great, 
but  in  spite  of  these  there  is  prompt  reaction  from  the 
shock  and  a  prompt  healing  is  soon  progressing.  On 
the  other  hand,  a  subject  affected  with  a  sapping  fistula 
that  has  been  draining  the  system  for  months  may  be 
too  feeble  from  anemia  and  chronic  septicemia  to  with- 
stand even  a  minor  operation.  The  one  will  recover, 
the  other  may  die. 

Scrawny,  ill-wintered  colts  fall  victims  of  castration, 
while  the  vigorous  seldom  die.  I  know  of  no  greater 
hazard  than  herniotomy  or  cryptorchidectomy  in  en- 
feebled subjects.  In  the  case  of  accidentally  inflicted 
wounds,  precisely  as  in  surgical  wounds,  there  is  this 
same  element  of  vigor  working  for  or  against  the  sur- 
geon, and  unless  due  attention  is  given  thereto,  wound 
healing  may  take  a  bad  turn  right  from  the  beginning, 
even  if  the  patient  recovers  from  the  shock  inflicted. 
Case  after  case  might  be  related  to  illustrate  this  point. 
It  should,  however,  be  sufficient  to  say  that  the  vigor  of 
our  animal  patients  has  such  a  marked  effect  upon  the 
results  of  our  surgery  that  no  surgical  operation  should 
ever  be  thought  of  without  first  giving  due  considera- 
tion to  the  influence  the  general  health  will  have  upon 
the  final  results. 

The  remedy  in  other  than  urgent  cases  is  to  improve 
the  patient 's  condition  by  every  available  and  practicable 
means.     I  have   often   postponed  poll-evil   and  fistul^e 


TREATMENT  OF  WOUNDS  71 

operations  for  ten  days  to  two  weeks  pending  an  im- 
provement of  the  patient.  The  abscesses  were  lanced 
and  irrigated  and  the  patient,  previously  working  per- 
haps, was  rested,  groomed,  fed  well,  and  medicated  until 
a  better  state  of  health  was  induced.  The  loss  in  time  in 
such  cases  turns  to  actual  gain  in  the  more  speedy  recov- 
ery— that  is,  in  the  more  rapid  healing  of  the  wound. 
The  hairy,  pot-bellied  colt,  that  has  subsisted  on  rough- 
age all  winter,  should  get  the  invigorating  effect  of  two 
weeks  at  pasture  before  it  is  castrated,  and  like  precau- 
tions should  be  taken  throughout  the  whole  category  of 
surgical  operations. 

In  emergency  cases  the  weak  require,  as  a  remedy 
against  their  enfeebled  state,  a  much  more  painstaking 
method  of  procedure  to  prevent  infection,  more  careful 
anesthesia,  and  a  more  constant  and  diligent  after-care. 
It  is  here  that  vaccines  find  their  greatest  usefulness  in 
animal  surgery.  Although  general  systemic  enfeeble- 
ment  does  not  always  indicate  a  low  opsonic  index,  our 
observations  lead  to  the  conclusion  that  vaccines  wield 
a  powerful  influence  for  good  in  the  great  majority  of 
cases  of  this  type. 

The  administration  of  iron,  quinin,  and  potassium  iodid 
to  encourage  a  better  behavior  of  wounds  has  many 
defenders,  and  no  doubt  serves  as  a  more  or  less  valu- 
able adjunct  to  the  feeding,  bedding,  grooming,  and 
general  care  of  weak  surgical  subjects. 

Another  point  in  the  preoperative  attention  of  pa« 
tients  is  the  care  of  the  feet.  Any  horse  about  to  be 
subjected  to  a  surgical  operation,  whether  the  wound  is 
intentional  or  accidental,  should  be  given  the  benefit  of 
good  "underpinning."  The  shoes  should  be  removed 
and  the  feet  pared  and  then  reshod,  so  as  to  give  the 
most  comfort.  This  is  particularly  important  when  the 
standing  position  must  be  maintained  day  after  day. 


72  WOUND  TREATMENT 

In  operations  upon  the  feet  for  disabling  lamenesses, 
there  is  nothing  so  important  as  the  opposite  leg  and 
foot,  which  must  now  bear  the  burden  of  two.  While 
the  patient  is  still  on  the  table,  the  shoeing  of  the  oppo- 
site foot  should  be  scrutinized,  and  corrected  if  neces- 
sary. The  sound  leg,  becoming  tired,  the  weak  patient 
will  often  lie  down  and  refuse  to  rise  to  bear  the  weight 
on  the  aching  member.  Such  cases  soon  become  bed- 
ridden, and  seldom  recover. 

In  fine,  it  might  be  truthfully  said  that  no  surgeon 
of  animals  will  have  success  with  serious  operations  if 
he  wades  into  them  with  a  reckless  disregard  for  the 
resistant  powers  of  his  patients.  The  surgeon  of  human 
beings  studies  his  patient  for  days.  He  puts  him  to  bed, 
diets  him,  purges  him,  stimulates  him,  examines  his 
urine,  his  blood  pressure,  his  heart,  and  then  finally  de- 
cides to  operate.  But  we  veterinarians  often  wade  into 
our  patients  without  a  forethought,  and  then  wonder  at 
the  mortality. 

The  operations  in  which  there  is  an  especial  need  of 
weighing  carefully  the  vigor  of  the  patient  in  order  to 
forestall  disaster  are  more  numerous  than  might  at  first 
be  supposed.     The  more  common  are: 

1.  Radical  operation  against  poll-evil. 

2.  Radical  operation  against  fistula  of  the  withers. 

3.  Ablation    of    scirrhous    cords,    botryomycomata,    shoe    boils; 

goiters,  nasal  tumors,  eyeballs,  and  so  on. 

4.  Radical  operations  for  large  hernia-ventraloceles,  oscheoceles, 

and  exomphaloceles. 

5.  Cryptorchidectomy. 

6.  Operations  upon  infected  tendon  sheaths  and  articulations. 

7.  Surgical  treatment  of  large  lacerations  of  the  buttocks  and 

shoulders. 

8.  Surgical  treatment  of  abdominal  wounds  with  visceral  injury. 

9.  Amputations  following  serious  accidents. 

A  review  of  these  procedures,  and  there  are  many 
others,  shows  clearly  that  major  operations  of  a  serious 


TREATMENT  OF  WOUNDS  73 

character — serious  on  account  of  the  magnitude  of  the 
traumatism — are  indeed  numerous.  They  include  the 
surgical  operations  of  animals  that  are  actually  worth 
the  trouble  and  expense  entailed  in  their  performance 
and  after-care,  because  the  salvage  is  always  consider- 
able and  in  most  cases  amounts  to  the  full  value  of  the 
individual  afflicted.  The  existence  of  animal  surgery 
therefore  depends  largely  upon  our  ability  to  work  out 
plans  of  wound  treatment  that  will  carry  such  patients 
safely  and  promptly  through  the  period  intervening  be- 
tw^een  the  completion  of  the  operation  and  the  final 
cicatrization  of  the  wound.  In  short,  to  make  animal 
surgery  actually  worth  while  we  must  make,  and  then 
manage,  large  wounds  better  than  we  have  done  hereto- 
fore. 

Previously  in  this  article  we  endeavored  to  show  that 
the  initial  fault  in  wound,  treatment  is  the  lack  of 
effort  we  make  in  the  preoperative  examination  of  our 
surgical  subjects.  To  wade  recklessly  into  a  patient  be- 
fore weighing  carefully  its  ability  to  bear  the  effect  of 
the  traumatism  we  are  about  to  inflict  seems  to  be  a  sin 
we  continue  to  commit.  In  view  of  the  other  obstacles 
under  which  wound  healing  in  animals  must  proceed 
it  is  plainly  important  to  start  out  with  the  best  phys- 
ical condition  it  is  possible  to  produce.  Every  means 
at  our  command  should  be  drawn  upon  to  accomplish 
this  end. 

I  shall  repeat  that  our  best  surgical  subjects  are 
those  well  cared  for,  well  fed,  and  worked  enough  to 
keep  them  muscular,  and  the  poorest  risks  are  those 
badly  fed,  worked  hard,  and  housed  in  poorly  venti- 
lated stables.  To  the  latter  may  be  added  animals  sick 
and  enfeebled  from  the  disease  for  which  they  are  to 
be  operated  upon.  The  former  stand  surgery  well,  while 
the  latter  are  victims  of  complications;  the  former  need 


74  WOUND  TREATMENT 

only  a  preparatory  dieting  to  avert  operative  accidents, 
while  the  latter  are  seldom  fit  for  major  surgery  until 
the  lost  vitality  has  been  restored.  A  physical  examina- 
tion for  pulmonary,  cardiac,  digestive,  and  locomotory 
disorders  is  particularly  demanded.  Urine  analysis, 
blood  counting,  and  bacteriological  tests  of  discharges 
and  secretions  are  less  called  for  in  animal  surgery  than 
in  surgery  of  human  beings,  and  in  fact  are  only  sel- 
dom of  sufficient  importance  to  warrant  one  in  resorting 
to  them,  but  the  knowing  animal  specialist  comes  to 
conclusions  about  the  physical  condition  of  his  patients 
by  their  general  appearance  and  the  lives  they  have 
previously  led. 

The  Cost  of  Better  Wound  Treatment 

The  question  of  cost  always  enters  into  any  detailed 
dissertation  on  surgical  operations.  It  is  usually  thought 
imprudent  to  add  still  more  to  the  already  high  over- 
head expense  of  our  surgical  work.  To  eliminate  the 
necessity  of  referring  to  this  feature  again,  we  shall 
state  flatly  that  the  actual  value  of  our  surgical  opera- 
tions is  not  reflected  in  the  prices  in  vogue  to-day.  The 
veterinarian  should  make  them  more  valuable  by  doing 
better  work.  This  is  the  pure  and  simple  solution  of 
the  ridiculously  low  prices  we  receive  for  our  surgical 
services.  A  scale  of  prices  should  be  an  elastic  scale. 
We  must  do  what  the  surgeons  of  human  beings  do: 
operate  upon  the  poor  for  nothing,  and  claim  a  reason- 
able fee  where  the  cost  is  less  an  object.  In  veterinary 
surgery  we  should  operate  upon  cheap  animals  for  less 
than  upon  those  where  the  salvage  is  great.  Five,  ten, 
fifteen,  or  twenty  dollars  may  be  ill  spent  for  an  opera- 
tion that  ends  unsuccessfully  or  in  a  long  convalescence ; 
while  twice  these  amounts  for  operations  that  promptly 


TREATMENT  OF  WOUNDS  75 

restore  useless  animals  to  their  full  value  would  be  re- 
garded as  good  investments. 

Operations  upon  cheap  animals,  performed  with  a  thor- 
oughness that  makes  for  good  results,  will  always  amply 
pay  the  surgeon  in  experience  if  not  in  money ;  and  this 
experience  can  always  be  turned  to  good  use  when  con- 
ditions are  more  favorable  for  the  collection  of  a  good 
fee.  Any  attempt  to  arrange  prices  on  any  other  basis 
is  destined  to  failure.  It  is  becoming  more  and  more 
evident  that  better  surgery  offers  us  the  best  oppor- 
tunity to  increase  our  incomes. 

A  Few  Words  on  Asepsis 

The  precautions  for  preventing  the  contamination  of 
wounds  while  making  them,  or  while  treating  those 
accidentally  inflicted,  have  revolutionized  the  surgical 
art.  To-day  the  surgeon  must  work  religiously 
throughout  an  operation  to  prevent  the  soiling  of  tis- 
sues with  infection,  and  this  has  greatly  complicated 
surgical  technic.  The  mere  cutting  process  is  often 
much  simpler  than  that  of  preventing  the  open  tis- 
sue from  becoming  contaminated  with  pathogenic  bac- 
teria. Surgery  includes  to-day  not  only  the  classical 
incisions,  resections,  and  dissections,  but  also  a  compli- 
cated prearranged  plan  for  performing  these  opera- 
tions without  depositing  harmful  bacteria  into  the 
trauma.  The  fact  that  bacteria  are  harbored  upon  and 
within  all  objects  directly  and  indirectly  connected  with 
the  procedure,  calls  for  preventive  measures  that  are  by 
no  means  easy  to  carry  out.  The  prevention  of  opera- 
tive infection  requires  knowledge  of  bacteriology  and 
pathology  that  is  not  possessed  by  the  charlatan,  and 
it  is  here  that  the  educated  practitioner  can  find  the 
greatest  weapon  to  use  against  his  charlatan  competitor. 


76  WOUND  TREATMENT 

There  are  a  certain  definite  number  of  objects  that 
touch  wounds,  and  aseptic  surgery  might  be  correctly 
defined  as  the  art  of  preventing  these  from  inoculating 
bacteria  into  them. 

The  air,  the  instruments,  the  surgeon's  hands,  the 
assistant's  hands,  the  surgeon's  clothing,  the  assistant's 
clothing,  the  operating  place,  the  sponges,  the  solutions, 
the  containers  of  solutions,  the  sutures,  the  dressings  and 
bandages,  the  surroundings  of  the  wound  (surgical  field), 
and  the  patient's  habitat  include  all  of  the  objects  ca- 
pable of  conveying  infection.  Aseptic  surgery  dictates 
a  rigid  handling  of  all  of  these  objects.  None  must  be 
ignored;  each  must  be  made  absolutely  harmless,  or  at 
least  as  nearly  harmless  as  is  possible  and  practicable. 
To  make  a  sane  effort  to  prevent  wound  contamination 
from  each  of  these  conveyors  in  every  operation  is  a 
modernism  that  should  no  longer  be  neglected  in  vet- 
erinary practice.  The  methodical  handling  of  these  to 
this  end,  in  a  surgical  operation,  is  an  exhibition  of 
knowledge  and  of  skill — a  spectacle  deserving  of  praise^ 
and  sure  to  win  applause  from  intelligent  judges,  anda- 
means  of  accomplishing  the  best  results.  The  veteri- 
narian should  realize  there  is  also  a  legal  side  to  this  ques- 
tion: that  he  may  be  made  accountable  for  infections 
of  his  own  making,  when  precautionary  measures  have 
been  disregarded. 

Air  as  a  Conveyor  of  Infection 

Except  where  patients  can.be  taken  out  into  the  open, 
on  a  clean  grass  plot  away  from  the  dust  of  trodden 
corrals,  roads,  or  tilled  fields,  the  air  is  capable  of  convey- 
ing dangerous  infections.  The  air  itself  acts  only  as  a 
carrier  of  particles  which  in  turn  carry  bacteria.  When 
there  are  no  particles  suspended  in  the  air  it  is  harm- 


TREATMENT  OF  WOUNDS  77 

less;  when  it  is  laden  with  suspended  or  flying  particles 
it  must  be  reckoned  with,  and  is  probably  more  often 
the  source  of  mysterious  wound  infections  than  we  at 
first  supposed. 

In  my  earlier  teachings  I  was  inclined  to  make  light 
of  the  possibilities  of  wound  infections  from  this  source, 
just  as  the  surgeons  of  human  beings  were  doing  after 
they  demonstrated  the  fallacies  of  Lister's  historical 
' '  phenicated  cloud. ' '  But  a  wider  experience  has  taught 
me  that  the  air  of  stables,  and  especially  of  veterinary 
hospitals,  is  quite  different  in  this  regard  from  that  of 
hospitals  for  human  beings. 

While  it  is  no  doubt  a  fact  that  most  of  our  infections 
come  from  other  sources,  the  air  of  our  operating 
rooms  is  not  to  be  entirely  ignored.  Such  rooms  are 
usually  dust  laden,  the  dust  originating  from  badly  con- 
taminated floors,  and  even  when  measures  are  taken  to 
allay  dust,  the  room  may  become  recontaminated  around 
the  surgical  field  with  dust  raised  from  the  patient's 
body.  The  body  of  a  struggling  animal  may  thus  be- 
come a  veritable  pest.  Dust  and  hairs  loosened  by  strug- 
gles and  then  whirled  about  by  drafts  often  create  very 
dangerous  conditions  and  are  diflieult  to  manage.  We 
would  be  making  a  poor  start  toward  perfection  in  asep- 
tic practice  w^ere  we  to  continue  to  disregard  these 
dangers. 

Refined  nosocomial  work  demands  special  care  to  al- 
lay suspended  room  dust  by  spraying,  and  to  prevent 
the  raising  of  dust  by  mopping  and  flooding  floors  in- 
stead of  sweeping,  and  by  wiping  furniture  and  uten- 
sils instead  of  dusting  them.  When  these  precautions 
have  been  taken  the  patient  itself  might  be  brought  in, 
well  groomed  and  moistened  with  a  damp  cloth  to  re- 
duce to  the  minimum  the  amount  of  dust  raised  from 
the  body.     This  latter  recommendation  is  particularly 


78  WOUND  TREATMENT 

important  around  the  surgical  field.  These  environs  may 
even  be  well  soaked  with  water. 

For  the  outdoor  operation  the  trodden  corral  and 
tilled  field  are  particularly  dangerous,  for  the  dust  from 
these  sources  is  ridden  with  bacteria  of  the  most  harm- 
ful sort,  and  usually  there  is  wind  to  whirl  about  the 
particles  raised  by  the  patient's  struggles. 

Youngsters,  either  equines  or  bovines,  shedding  the 
long  shaggy  winter  coat,  are  about  the  most  miserable 
surgical  prospects  imaginable.  In  operations  upon  such 
animals  great  clouds  or  even  bunches  of  hairs  are  some- 
times swept  into  wounds,  and  if  there  is  added  to  this 
the  dust  from  a  bare  paddock  the  condition  is  abom- 
inable and  strictly  unfit  for  any  kind  of  surgical  work. 

The  use  of  any  kind  of  litter  as  an  operating  bed  may 
likewise  be  condemned.  There  is  no  fit  litter  for  sur- 
gical work.  A  ban  might  as  well  be  put  on  all  kinds 
of  loose  beddings  used  to  make  a  soft  place  for  re- 
strained animals  to  lie  upon  during  operations,  for  it  is 
positively  impossible  to  maintain  a  decent  state  of  sur- 
gical cleanliness  with  loose  particles  whirled  or  trailed 
into  or  near  the  wound  at  every  movement.  Whenever 
the  weather  is  too  inclement  for  outdoor  work  it  is  bet- 
ter to  cast  animals  upon  a  bare  floor,  protecting  the 
head  and  hips  with  blankets  if  thought  necessary.  The 
actual  difference  between  a  bare  floor  and  a  floor  bedded 
with  two  or  three  inches  of  straw  is  not  great,  measured 
from  the  standpoint  of  the  patient's  comfort.  Beddings 
are  usually  pushed  aside  and  the  body  rests  upon  the 
floor  before  the  operation  is  far  advanced,  and  about  the 
only  good  accomplished  by  the  bedding  is  the  psycho- 
logical effect  it  has  upon  the  audience.  Shavings  prop- 
erly  moistened  can  be  controlled  better  than  any  other 
bedding,  but  these  are  seldom  available  and  are  none 
too  safe.     It  is  better  to  abandon  entirely  the  use  of 


TREATMENT  OF  WOUNDS  79 

litter  as  a  surgical  appurtenance,  and  thus  dispose  of 
one  of  the  sources  of  air  contamination. 

In  short,  air  is  a  prolific  source  of  wound  infection 
in  animal  surgery  that  should  be  dealt  with  consistently. 
It  is  not  so  dangerous  as  Lister  taught  before  the  days 
of  bacteriology,  but  more  dangerous  for  veterinarians 
than  for  the  surgeons  of  human  beings,  who  operate 
under  much  more  favorable  conditions  than  is  ever 
possible  for  us. 

Instruments  as  Conveyors  of  Infection 

As  instruments  come  into  direct  contact  with  wounds 
they  are  more  certain  to  inoculate  them  than  the  other 
objects  used  in  wound  treatment.  The  metallic  instru- 
ments used  in  surgical  work  (knives,  forceps,  and  so 
on)  become  progressively  more  dangerous  day  after  day 
unless  submitted  to  an  effectual  sterilization.  That  is, 
instruments  used  from  the  pocket  case  or  from  shelves 
of  the  instrument  case  soon  become  very  dangerous. 
They  will  infect  every  raw  spot  they  touch  with  appal- 
ling certainty. 

Wound  infection  from  this  source  is  avoidable  under 
all  circumstances  in  veterinary  as  in  human  sargery, 
and  should  therefore  be  entirely  eliminated.  There  is 
absolutely  no  excuse  for  wound  infection  from  instru- 
ments. They  can  and  should  be  sterilized  before  every 
operation  and  then  so  handled  during  an  operation  as 
to  prevent  them  from  becoming  contaminated.  Veteri- 
narians who  continue  to  operate  without  first  sterilizing 
their  instruments  are  fortunately  fewer  than  formerly, 
but  I  regret  to  say  they  are  still  legion. 

Boiling  is  by  far  the  easiest  as  well  as  the  safest 
method  of  making  instruments  safe.  To  assure  safety, 
metallic  instruments  should  be  boiled  ten  to  fifteen  min- 


80  WOUND  TREATMENT 

iites.  Cutting  instruments  are  harmed  somewhat  by 
repeated  prolonged  heating ;  our  present  plan  is  to  pick 
up  the  knives  from  the  boiling  water  after  two  or  three 
minutes  and  complete  the  sterilization  by  placing  them 
in  a  jar  containing  denatured  alcohol.  Alcohol  steriliza- 
tion alone  for  scalpels  and  bistouries  is  depended  upon 
by  many,  and  if  the  immersion  is  long  it  may  be  regarded 
an  appropriate  and  safe  expedient  for  the  particular 
purpose  of  assuring  the  best  sterilization  possible  with- 
out injuring  the  keen  edges  of  sharp  knives. 

Rubber  goods  (gloves,  catheters,  drainage  tubes, 
syringes)  may  be  subjected  to  a  certain  amount  of 
boiling  without  injury,  and  as  these  are  not  as  a  rule 
very  costly,  such  injury  as  they  do  sustain  is  unim- 
portant. Costly  instruments  of  this  class  can  also  be 
made  safe  by  immersing  them  for  some  time  in  strong 
solutions  of  mercuric  chlorid. 

The  resoiling  of  instruments  during  operations  must 
be  prevented  by  taking  care  that  they  do  not  come  in 
contact  with  soiled  objects.  If  they  become  infected  by 
contact  'with  pus  or  other  infected  substances  they 
should  be  set  aside  and  not  placed  upon  or  near  clean 
instruments  on  the  tray.  The  use  of  a  little  caution 
and  plenty  of  common  sense  is  needed  in  handling  in- 
struments, for  otherwise  the  whole  plan  of  clean  operat- 
ing will  be  futile. 

The  Surgeon's  and  the  Assistant's  Hands 

The  hands  as  carriers  of  infection  into  wounds  we 
treat  deserve  more  than  ordinary  consideration,  because 
the  hands  of  surgeons  practicing  among  animals  are 
always  liable  to  infect  wounds.  In  short,  the  hands 
belong  to  the  first  rank  as  infection  carriers,  not  only 
of  ordinary  pyogenic  infection  but  also  of  infections  of 


TREATMENT  OF  WOUNDS  81 

more  serious  import.  Working  continually  among  in- 
fected objects  and  infected  structures  of  the  body  of 
diseased  animals  that  must  be  handled  manually,  the 
veterinarian  who  indulges  in  major  surgical  work,  or 
who  desires  to  have  nice  results  from  his  minor  work, 
must  learn  first  of  all  that  his  hands  are  dangerous 
and  unless  managed  properly  will  defeat  his  every  other 
precaution  to  perform  aseptic  operations.  The  hands 
that  remove  a  putrefied  placenta  or  decomposed  fetus  are 
not  fit  to  handle  internal  organs  or  raw  wound  sur- 
face* for  some  time,  even  when  careful  washing  precedes 
the  operation,  for  no  washing,  no  matter  how  carefully 
done,  will  immediately  rid  them  of  infectious  material. 

The  exact  truth  in  this  connection  is  that  bare  hands 
are  never  safe.  Even  the  hands  of  the  human  surgeon 
are  not  so  regarded,  and  his  work  is  by  no  means  of 
such  a  filthy  character  as  that  of  the  veterinarian. 
Just  before  operating,  the  veterinarian  is  often  engaged 
in  much  dirty  preparatory  work — casting  or  otherwise 
securing  his  patient.  The  paraphernalia  used  around 
a  veterinary  surgical  operation  is  dirty  in  the  surgical 
sense  and  abominably  contaminated  with  the  dirt  of 
preceding  operations.  As  these  must  be  handled  with 
the  hands,  there  is  little  chance  of  the  veterinarian  ever 
having  hands  that  are  fit  to  handle  tissues  or  instru- 
ments that  must  come  in  contact  with  tissues.  And 
since  the  wearing  of  sterilized,  skin-tight  rubber  gloves 
is  not  practicable  for  ordinary  operations,  it  would 
seem   that   we   here   meet   an   insurmountable   obstacle. 

The  truth  is,  however,  quite  different,  for  if  we  prac- 
tice the  art  of  avoiding  the  digital  manipulation  of  raw 
surfaces  the  obstacle  is  at  once  removed,  no  matter  how 
dirty  the  hands  are.  Ablutions  of  soap  and  water  fol- 
lowed by  a  rinsing  in  mercuric  chlorid  are  all  that  is 
needed  to  prevent  infection  from  the  hands  when  han- 


82  WOUND  TREATMENT 

dling  the  tissues  with  the  fingers  can  be  avoided.  While 
such  hands  still  harbor  and  deposit  infections,  they 
touch  only  the  handles  of  instruments;  the  blade  of  the 
scalpel  and  the  jaw  of  the  forceps  are  not  soiled,  and 
thus  do  not  convey  hand  contaminations.  By  exercising 
a  little  care  to  prevent  the  handles  of  instruments  thus 
soiled  from  touching  the  parts  of  other  instruments  on 
the  tray  that  will  be  subsequently  used  on  the  raw 
tissues,  the  infection  of  wounds  with  the  hands  becomes 
negligible  in  veterinary  surgical  operations  in  spite  of 
the  fact  that  they  are  all  the  while  badly  contaminated 
with  bacteria.  In  addition,  however,  we  must  not  forget 
the  assistant's  hands.  These  come  into  even  closer  con- 
tact with  the  wound  while  baling  blood  than  those  of 
the  surgeon  himself.  In  handling  sponges  the  assistant 
must  endeavor  throughout  to  keep  the  part  of  the  sponge 
he  touches  with  the  fingers  from  touching  the  wound— 
a  plan  easy  of  execution — and  under  no  circumstances 
should  he  bring  his  fingers  directly  into  contact  with 
the  wound.  When  he  hands  instruments  to  the  surgeon 
he  should  touch  only  the  handles  or  convey  them  with 
forceps.  The  rules  we  have  put  into  operation  to  pre- 
vent wound  infections  from  the  hands  are  as  follows: 

1.  Avoid    all    unnecessary    handling    of    raw    tissues    with    the 

fingers. 

2.  Einse  the  hands  with  mercuric  chlorid  (1  to  500)  after  wash- 

ing them  with  soap  and  water.  During  the  operation  rinse 
them  frequently  in  a  deep  basin  provided  for  the  purpose. 

3.  Wear  gloves  while  scouring  the  patient. 

4.  Touch  only  the  handles  of  instruments  that  contact  raw  sur- 

faces, and  so  arrange  them  on  the  tray  that  the  handles  will 
not  come  into  contact  with  the  blades  of  knives  or  jaws  of 
forceps  that  will  subsequently  be  used  on  the  raw  surfaces. 

5.  Handle  needles  and  sutures  with  the  forceps  only,  or  wear 

sterilized  skin-tight  gloves  while  suturing. 

6.  Soak  sutures  previously  sterilized  in  tincture  of  iodin  so  that 

soiling  will  be  less  harmful. 

7.  Where   digital  manipulations   are   needed,   as   in   spaying   or 

ridgling  castration,  the  hands  cannot  be  made  entirely  :safe. 
Washing  with  water,  rinsing  in  mercuric  chlorid  solution, 


TREATMENT  OF  WOUNDS  83 

rubbing  them  with  alcohol,  and  then  painting  the  fingers  in 
weakened  tincture  of  iodin  combines  the  best  resources  we 
have.  The  latter — the  iodin — is  objectionable,  because  of 
the  staining  and  because  it  blunts  the  tactile  sense,  so  much 
depended  upon  when  digital  work  is  actually  necessary. 

Wearing  clean  gloves  while  doing  the  preparatory 
work,  the  washing  and  rinsing  of  the  hands  as  above 
proposed,  avoiding  unnecessary  manipulations  with  the 
fingers,  and  wearing  sterilized,  skin-tight  gloves  while 
suturing  are  just  so  many  practical  means  of  averting 
wound  infection  from  the  hands,  and  when  these  simple 
means  are  resorted  to  hand  infections  are  comparatively 
rare.  There  remain  the  unavoidable  infections  when 
the  bare  hands  must  be  used. 

Sponges 

Absorbent  cotton  is  the  best  sponging  material  for 
general  use  in  veterinary  practice,  especially  where  a 
large  number  of  sponges  will  be  needed  during  a  given 
operation.  Gauze  comes  second,  and  while  decidedly  the 
safer,  absorbent  cotton  is  delivered  in  clean  packages 
and  is  easily  sterilized  whenever  absolute  purity  is  de- 
manded. Our  plan  of  handling  cotton  for  important 
operations  is  to  place  a  sufficient  amount  in  the  sterilizer 
with  the  instruments  and  when  well  boiled  cool  it  off  in 
a  basin  of  mercuric  chlorid  solution  (1  to  1,000)  made 
with  sterile  water.  This  is  then  the  assistant's  basin. 
During  the  operation  he  takes  his  sponges  from  this 
basin  as  fast  as  they  are  needed  and  of  course  casts 
them  aside  when  soiled.  This  plan  tends  to  keep  the 
assistant's  hands  safer  by  their  repeated  contact  with 
the  antiseptic  solution  containing  the  cotton. 

Where  there  are  plenty  of  especially  assigned  assist- 
ants to  look  after  the  surgical  paraphernalia,  as  in 
college  clinics,  sterile  gauze  sponges  used  in  the  same 


84  WOUND  TREATMENT 

way  are  preferable.    These  may  be  resterilized  for  future 
use. 

Sponge  sponges  are  very  effectual  in  absorbing  blood 
from  wounds,  and  on  this  account  are  defended  as  best 
by  some  veterinarians.  By  keeping  them  in  a  strong 
antiseptic  solution  they  can  of  course  be  sterilized,  but 
unless  these  are  used  like  the  gauze  and  cotton  sponges, 
being  cast  aside  when  soiled,  their  use  cannot  be  recom- 
mended under  any  circumstance.  It  is  best  to  dispense 
entirely  with  the  sponge  and  at  once  eliminate  a  very 
common  source  of  wound  infection. 

Solutions  and  Their  Containers 

There  is  no  material  about  veterinary  surgical  opera- 
tions more  erroneously  used  than  the  antiseptic  solution. 
I  find  that  veterinarians  are  still  placing  too  much 
dependence  upon  the  microbicidal  value  of  chemical 
substances  dissolved  for  surgical  use.  Unless  the  water, 
the  basin,  and  even  the  drug  are  sterilized,  no  antiseptic 
solution  is  safe.  In  fact,  antiseptic  solutions  are  one 
of  the  commonest  sources  of  wound  contamination.  They 
soil  more  than  they  are  capable  of  disinfecting.  They 
carry  bacteria  into  wounds  where  none  previously  ex- 
isted, and  they  are  ineffective  against  bacteria  lodged  in 
the  tissues.  The  statement  that  pathogenic  bacteria  are 
more  viable  than  the  cells  of  the  body  cannot  be  too  often 
repeated.  The  explanation  of  the  stubbornness  of  wound 
infections  against  antiseptics  is  found  therein.  The 
simple  truth  is  that  antiseptics  injure,  devitalize,  and 
even  kill  cells  to  the  advantage  rather  than  to  the  dis- 
advantage of  bacteria  growth. 

From  these  facts  it  is  evident  that  the  antiseptic  solu- 
tions we  use  should  be  more  intelligently  prepared  and 
handled  than  is  customary  in  veterinary  surgical  opera- 


TREATMENT  OP  WOUNDS  85 

tions.  Water  from  the  well  or  hydrant  brought  in  the 
milk  pail  or  stable  bucket,  no  matter  how  clean  looking 
it  may  be,  is  a  sure  carrier  of  infection.  To  add  to  this 
water  an  antiseptic  drug  does  not  improve  matters  as 
much  as  is  generally  supposed;  the  solution  is  still  an 
infection  carrier  of  the  most  certain  sort.  Experimen- 
tal studies  of  the  viability  of  various  microbes  in  the 
different  solutions  used  in  surgical  operations  tell  plainly 
enough  why  wound  infection  from  this  source  is  so  com- 
mon. Sterilized  water  held  in  a  sterilized  basin  without 
any  antiseptic  drug  is  much  safer  than  medicated  water 
that  is  laden  with  bacteria,  as  almost  all  waters  are. 

Analyzing  the  reason  why  sterilized  w^ater  is  still  so 
rarely  found  in  veterinary  operations,  I  find  that  the 
principal  argument  against  the  use  of  this  valuable  and 
very  inexpensive  product  is  that  water  boiled  just  as 
the  animal  is  about  to  be  operated  upon  is  always 
brought  to  the  scene  of  the  operation  too  hot  to  be 
handled,  and  as  it  does  not  cool  very  fast  there  is  always 
an  inclination,  in  the  haste  of  getting  through  with  the 
work,  to  cool  it  off  with  cold  water.  This  of  course 
spoils  everything;  and  knowing  this,  the  country  vet- 
erinarian soon  abandons  his  effort  to  stick  strictly  to 
this  product  as  a  menstruum  for  his  solutions. 

It  is,  however,  worth  while  insisting  that  every  drop 
of  water  to  be  used  in  any  important  operation  should 
be  boiled  for  fifteen  minutes  and  brought  out  in  the 
original  vessel.  The  time  allowed  for  it  to  cool  is  time 
well  spent.  In  my  rural  operations  I  frequently  fill  the 
large  wash  boiler  with  water,  place  in  it  the  basins, 
dipper,  bandages,  and  sponges  to  be  used,  and  then  boil 
all  together  for  fifteen  minutes.  In  the  meantime  the 
instruments  are  being  boiled  in  the  regular  instrument 
sterilizer — an  apparatus  that  every  veterinarian  should 
carry  with  him  everywhere.     It  requires  about  fifteen 


86  WOUND  TREATMENT 

to  twenty  minutes  for  these  to  cool  oft',  and  this  time 
can  be  utilized  in  preparing  the  patient. 

This  is  a  general  plan  that  every  country  practitioner 
should  follow  sacredly.  The  unfortunate  sequences  of 
many  of  my  country  operations  during  past  years  I 
attribute  to  this  source  of  infection.  Suppuration  ga- 
lore, surgical  septicemia,  malignant  edema,  tetanus,  peri- 
tonitis, and  other  consequences  following  operations  that 
one  has  taken  especial  pains  to  do  well  may  often  he 
traced  to  had  judgment  in  providing  the  solutions. 

The  best  plan  the  country  veterinarian  can  lay  down 
as  a  start  for  better  surgery  is  the  use  of  the  housewife 's 
wash  boiler  in  the  manner  mentioned  above. 

In  hospital  operations  sterilized  water  is  more  easy  to 
procure.  It  can  be  stored  in  large  bottles  ready  for  use, 
and  the  instrument  sterilizer  should  be  large  enough  to 
sterilize  the  basins  into  which  the  water  is  poured.  Too 
much  dependence  must  not  be  placed  in  the  hot  water 
from  the  hot-water  tank  even  though  it  comes  out  steam- 
ing hot.  Tank  water  whose  temperature  is  maintained 
around  200  degrees  Fahrenheit  for  hours  is,  however, 
safe  enough  for  ordinary  surgical  work. 

Sutures 

The  certainty  of  wound  infection  from  unsterilized 
sutures  is  due  largely  to  the  fact  that  they  sojourn  so 
long  in  the  injured  tissues.  The  bacteria  they  carry 
always  find  a  favorable  environment  for  growth  in  the 
enfeebled  tissues  they  hold  together,  and  even  when 
sterilized  and  placed  with  exceptional  care,  stitch  sup- 
puration may  develop  from  skin  bacteria  that  cannot 
be  dislodged  in  the  preparation  of  the  surgical  field. 

On  these  accounts  sutures  in  veterinary  operations 
call  for  special  methods  of  handling.     They  must  first 


TREATMENT  OF  WOUNDS  87 

be  boiled  for  at  least  fifteen  minutes,  bathed  in  pure 
tincture  of  iodin,  and  then  so  handled  as  to  prevent 
contamination  through  trailing  over  unclean  places  or 
from  the  soiled  hands. 

We  defend  the  use  of  antiseptic  sutures  instead  of 
aseptic  sutures  chiefly  on  the  grounds  of  expediency. 
Such  sutures  can  be  handled  more  carelessly  with  the 
bare  hands,  they  are  less  apt  to  get  soiled  from  acci- 
dentally trailing  over  soiled  places  on  the  patient,  and 
stitch  suppuration  from  skin  bacteria  is  made  negligible. 
The  nature  of  our  operations  demands  this  expedient. 
This  applies,  of  course,  only  to  removable  sutures,  that  is, 
sutures  for  the  skin.  Buried  sutures  for  the  underlying 
integuments  need  not  be  so  treated,  but  should  always  be 
purchased  sterilized  and  in  sealed  containers.  The  veter- 
inarian has  no  way  of  safely  sterilizing  raw  gut,  and 
therefore  should  not  undertake  to  do  so. 

In  suturing  wounds  the  needle  is  held  in  the  needle- 
holder,  and  the  end  of  the  thread  that  is  handled  may  be 
cut  off  when  the  needle  is  threaded.  The  assistant  may 
then  keep  the  dangling  end  from  trailing  over  the  pa- 
tient by  holding  it  up  with  forceps  as  it  is  drawn 
through;  or  the  surgeon  may  at  this  stage  of  the  opera- 
tion put  on  a  pair  of  sterilized,  skin-tight  rubber  gloves 
and  handle  the  needle  and  thread  with  the  fingers,  keep- 
ing the  thread  in  the  palm  of  the  hand  to  prevent  trailing. 
Either  of  these  plans  will  answer. 

There  is  no  use  in  practicing  other  aseptic  precautions 
if  any  carelessness  whatever  in  handling  sutures  is  al- 
loAved  to  creep  in,  because  here  we  have  a  certain  infec- 
tion carrier.  A  wound  may  sometimes  escape  infection 
from  contaminated  air,  instruments,  or  hands,  but  never 
from  sutures  that  are  not  absolutely  aseptic  and  carefully 
handled. 


88  WOUND  TREATMENT 

Wound  Packing",  Drainage  Wicks,  and  Draining-  Tubes 

Inasmuch  as  we  continue  to  use  compression  packs  to 
control  copious  bleeding  after  some  of  our  operations, 
these  are  capable  of  acting  as  carriers  of  bad  infections. 
A  soiled  wound-pack  sewed  up  tightly  in  a  traumatic  cav- 
ity is  a  mighty  dangerous  object.  In  twenty-four  hours 
it  is  fetid,  and  in  forty-eight  hours,  if  not  removed  or  the 
sutures  loosened  to  admit  air,  malignant  edema  is  very 
likely  to  have  developed.  The  large  cavities  of  ridgling 
castration,  of  fistulse  of  the  withers,  of  poll  evils,  and  of 
large  tumors  are  to  be  feared  in  this  connection.  Re- 
cently a  case  of  this  kind  came  to  my  notice.  A  ridgling 
castrated  after  some  difficulty  was  packed  with  cotton 
that  was  simply  disinfected  in  mercuric  chlorid  solution 
made  from  well  water  and  contained  in  a  milk  pail.  The 
wadding  was  held  in  place  by  snapping  the  edges  of  the 
wound  with  a  clamp  forceps.  When  removed  forty-eight 
hours  later  the  wadding  was  fetid,  the  scrotum  was  swol- 
len, and  the  patient  stiff  and  sick.  There  was  a  per- 
ceptible emphysema  in  the  loose  areolar  tissue  along  the 
inguinal  canal.  Two  days  later  the  patient  was  swollen 
with  an  emphysematous  edema  along  the  ventral  surface 
of  the  body  as  far  forward  as  the  elbows.  Death  oc- 
curred a  few  hours  later.  I  have  had  similar  results  from 
operations  upon  fistula  of  the  withers  where  soiled  pack- 
ings were  injudiciously  allowed  to  remain  sewed  up  too 
long.  These  infections  are  wound-packing  infections,  and 
must  be  reckoned  with  in  w^ound  treatment. 

The  best  wound  packing  is  sterilized  oakum,  sterilized 
by  boiling  and  not  alone  with  antiseptics.  Oakum  is  bet- 
ter than  cotton  for  this  purpose  because  the  latter  stub- 
bornly mats  into  raw  tissues  and  stays  there  for  two  or 
three  days.  An  oakum  pack  comes  out  en  masse,  leaving 
no  particles  behind. 


TREATMENT  OF  WOUNDS  89 

For  wicks  to  act  as  drainage  in  counter  openings,  or  in 
the  lower  commissure  of  wounds,  sterilized  antiseptic 
gauze  is  most  suited.  Drainage  tubes  should  be  boiled 
before  being  fixed  into  a  wound. 

Protective  Dressings  as  Conveyors  of  Infection 

Banclages,  absorbent  cotton,  oakum,  collodium,  dust- 
ing powders,  and  wound  varnishes  are  the  objects  used 
as  protective  dressings.  The  truth  about  wound  treat- 
ment in  this  connection  is  that  a  wound  closed  without 
having  been  infected  in  the  process  of  treatment  is  not 
apt  to  become  infected  later.  Postoperative  infection  I 
know  is  often  a  very  convenient  cloak  to  cover  up  oper- 
ative infection.  The  castrator,  in  all  the  seriousness  of  a 
minister,  chastises  the  owner  of  a  dying  colt  for  having 
allowed  it  to  inhabit  a  dirty  stall  when  in  fact  the  infec- 
tion responsible  for  the  stricken  animal's  condition  was 
deposited  with  his  own  hands  or  his  own  unsterilized  or 
half -sterilized  emasculator,  at  the  time  of  the  operation, 
and  this  example  explains  the  mystery  of  nearly  all  our 
wound  infections. 

Collodium,  dusting  powders,  and  wound  varnishes  sel- 
dom convey  infections  because  they  are  clean,  antiseptic, 
and  drying.  Bandages  and  cotton,  however,  placed  over 
a  wound,  require  attention  as  infection  carriers.  I  am  a 
believer  in  antiseptic  wraps  for  wounds,  and  depend 
upon  aseptic  wraps  only  when  renewal  is  frequent.  An 
aseptic  bandage  that  becomes  soaked  with  wound  serosity, 
or  that  holds  wound  discharges  against  the  skin  around 
a  wound,  is  not  so  good  as  one  that  contains  iodoform, 
mercury,  or  carbolic  acid,  because  the  serum  in  such  a 
bandage  does  not  putrefy  as  soon  as  in  an  aseptic  wrap. 

It  is  our  practice  to  dust  a  powder  of  iodoform,  bis- 
muth subiodid,  or  boric  acid  over  the  wound  and  then 
cover  this  with  cotton  and  a  bandage  soaked  and  rinsed 
out  of  mercuric  chlorid  solution  (1  to  200).    With  these 


90  WOUND  TREATMENT 

simple  precautions  protective  dressings  are  deprived  of 
all  harm. 

The  Surgical  Field  as  a  Conveyor  of  Infection 

A  good  liberal  zone  around  a  wound  or  proposed  seat 
of  a  wound  must  be  submitted  to  the  classical  cleansing 
process,  now  regarded  as  standard  for  this  purpose.  It 
consists  in  washing  with  water  and  soap,  clipping,  shav- 
ing, rinsing,  and  rubbing  briskly  with  mercuric  chlorid 
(1  to  500),  and  then  painting  with  tincture  of  iodin. 
This  does  not  positively  sterilize  the  skin  of  a  hairy  ani- 
mal, but  it  combines  the  best  means  of  producing  the 
safest  possible  field  for  a  cutting  operation. 

The  surgical  field  conveys  infection  during  the  opera- 
tion by  being  directly  at  the  wound,  and  after  the  opera- 
tion by  the  growth  of  bacteria  on  the  serum-soaked  skin. 
It  is  therefore  evident  that  any  laxity  or  omission  here 
is  serious. 

Postoperative  Conveyors  of  Infection 

As  mentioned  in  the  foregoing  paragraphs,  postoper- 
ative infection  is  not  so  common  as  is  generally  supposed 
or,  better  still,  not  so  common  as  the  surgeon  would  have 
his  clients  believe.  That  there  are  postoperative  infec- 
tions is  of  course  admitted,  but  the  search  for  causes  will 
usually  be  more  successful  if  the  operative  methods  are 
scrutinized. 

It  is,  however,  plain  that  the  same  careful  handling  of 
everything  that  prevailed  during  the  operation  must  be 
continued  during  the  after-care,  especially  during  the 
first  four  days.  It  is  a  misfortune  to  be  compelled  to 
turn  over  the  after-care  of  wounds  to  untrained  hands, 
but  if  we  plan  our  after-care  with  this  in  view  we  can 


TREATMENT  OF  WOUNDS  91 

generally  succeed  in  keeping  our  really  aseptic  wounds 
from  harm. 

The  postoperative  conveyors  are  the  patient's  bed  and 
stall  and  the  attendant's  hands,  syringes,  solutions,  pow- 
ders, and  dressings. 

The  patient's  habitat  is  made  safe  by  keeping  the 
wound  covered,  keeping  the  patient  in  the  standing  posi- 
tion, and  keeping  up  a  sensible  state  of  cleanliness  in 
the  surroundings. 

The  handling  of  wounds  by  attendants  should  be 
avoided.  They  might  be  entrusted  with  the  dusting  of 
powder  on  a  sutured  wound,  applying  a  clean  piece  of 
gauze  or  cotton  and  wrapping  a  bandage  over  all,  but 
this  is  as  far  as  any  untrained  hands  should  be  trusted 
in  the  treatment  of  aseptic  wounds.  A  wound  requiring 
irrigation  and  renewal  of  drainage  wicks  or  tubes  re- 
quires also  the  intelligent  assistant  or  surgeon,  as  these 
means  are  sure  to  infect. 

Syringes  and  solutions  in  wound  treatment  should  be 
given  into  the  hands  of  others  only  in  the  treatment  of 
suppurating  cavities  where  refinement  is  unnecessary. 

I  would  summarize  the  plans  of  handling  the  various 
conveyors  of  infection  as  follows : 

1.  Operate  in  an  atmosphere  that  is  free  from  dust,  and  prevent 

objects  from  being  whirled  about  by  the  patient.  Avoid 
loose  bedding,  and  moisten  the  patient  to  keep  the  hair 
from  flying. 

2.  Boil  instruments  for  fifteen  minutes  and  so  handle  them  dur- 

ing the  operation  as  to  prevent  contamination.  Call  for 
other  instruments  to  replace  those  soiled. 

3.  Avoid  touching  the  wound  with  the  fingers.     Use  tissue  for- 

ceps, tumor  forceps,  and  needle  holders.  It  is  seldom  neces- 
sary to  touch  wounds  with  the  fingers.  When  digital  work 
is  necessary,  wash  the  hands,  rinse  them  in  mercuric  chlorid 
(1  to  500),  and  coat  the  finger  tips  with  tincture  of  iodin. 

4.  Use  only  sterilized  water  and  sterilized  basins. 

5.  Prepare   a  large   surgical  field  in  the   manner  above   recom- 

mended. 

6.  Use  sterilized   sutures  and  bathe  them  in  tincture   of  iodin. 

Keep  them  from  trailing  over  the  dirty  body.     Handle  them 


92  WOUND  TREATMENT 

with  tlie   needle  holder,  or  else  wear  sterilized,  skin-tight 
gloves  while  suturing. 

7.  Protect  wounds  with  antiseptic  dressings  instead  of  aseptic. 

8.  Attend  yourself  to  the  after-care  of  wounds  instead  of  trust- 

ing it  to  untrained  hands. 

9.  Prevent  wounds  from  coming  into  contact  with  the  stall,  bed- 

ding, or  ground. 

Classification  of  Wounds 

The  time-honored  custom  of  classifying  wounds  into 
incised,  lacerated,  punctured,  and  so  on,  although  almost 
consecrated  by  usage,  serves  no  useful  purpose  and  might 
therefore  be  entirely  discarded  in  the  study  of  wound 
treatment.  These  names  reflect  only  the  character  of  the 
causative  instrument,  and  that  without  giving  a  hint 
about  the  particular  treatment  they  might  require.  As 
a  basis  for  a  detailed  description  of  wound  treatment 
these  names  are  useless  unless  prefixed  with  simple,  per- 
pendicular, complex,  superficial,  oblique,  deep,  trans- 
verse, soiled,  mutilated,  sheltered,  venomous,  or  some 
other  descriptive  adjective  that  would  indicate  the  plan 
of  management. 

Take  for  example  an  incised  wound,  the  basis  of  nearly 
all  surgical  operations.  That  it  was  made  with  a  sharp 
instrument  is  less  important  in  the  treatment  than  the 
fact  that  it  was  made  with  a  dirty  knife,  that  its  direction 
is  such  that  it  cannot  be  drained,  or  that  it  is  located  in  a 
place  where  muscular  movements  cannot  be  controlled. 
These  are  a  few  of  the  elements  that  call  for  special  man- 
agement of  animal  wounds,  and  it  is  upon  these  that  a 
classification  should  be  based. 

The  classification  that  appeals  most  to  the  writer  is  one 
which  at  once  indicates  a  particular  plan  of  manage- 
ment, as  follows: 

1.  Aseptic  incised  wounds;  wounds  without  loss  of  tissue  or  in 

which  the  loss  is  not  great. 

2.  Wounds  with  loss  of  underlying  tissue  which  can  be  bridged 


TREATMENT  OF  WOUNDS  93 


over  with,  the   skin  and   whose   cavity   can   be   drained  by 
gravitation  of  the  discharges. 

3.  Wounds   that  cannot  be   drained  by  gravitation   of   the   dis- 

charges.    Open  wounds. 

4.  Venomous  wounds. 

5.  Punctured  wounds. 

6.  Gun-shot  wounds. 


Aseptic  Incised  Wounds 

These  are  always  surgical  wounds,  made  in  a  prepared 
field  with  a  sterilized  knife  and  touched  only  with  steri- 
lized objects — sponges,  hands,  solutions,  and  so  on.  In- 
cised wounds  accidentally  inflicted  must  never  be  placed 
in  this  category,  as  the  sickle,  razor,  scythe,  saber,  or  dag- 
ger capable  of  inflicting  them  are  not  aseptic  and  there- 
fore soil  the  tissues  in  the  process  of  making.  Although 
these  instruments  may  seem  clean,  they  are  actually 
poisonous  in  many  instances,  depositing  infections  that 
make  the  wound  behave  badly,  and  when  closed  with 
sutures  with  no  provisions  for  drainage  they  may  often 
end  in  a  threatening  if  not  fatal  septicemia. 

Treatment. — The  handling  of  this  class  of  wounds  is 
indeed  very  simple.  The  first  step  is  to  close  them  up 
completely  with  sutures  so  arranged  as  to  bring  and 
maintain  perfect  apposition  of  all  of  the  integuments — 
skin,  fascia,  and  muscle.  Each  integument — usually  only 
the  skin  is  involved — is  brought  into  very  accurate  con- 
tact without,  however,  tightening  any  part  sufficiently 
to  cause  stitch  necrosis.  Sutures  that  have  been  boiled 
fifteen  minutes  and  then  bathed  in  pure  tincture  of 
iodin  are  the  only  sutures  we  use  for  this  purpose.  As 
we  have  previously  mentioned,  these  are  recommended 
because  they  are  seldom  soiled  in  the  handling. 

The  second  step  is  the  protection  against  infection  dur- 
ing the  succeeding  seven  or  eight  days.  The  best  method 
is  a  varnish  of  coUodium  applied  layer  after  layer  as 


94  WOUND  TREATMENT 

soon  as  the  wound  and  environs  can  be  dried  of  blood 
and  moisture.  Collodium  serves  the  double  purpose  of 
protecting  against  soiling  and  of  supporting  the  sutures. 
On  the  limbs  where  bandaging  is  feasible,  smothering 
such  a  wound  with  iodoform  or  bismuth  subiodid,  pure  or 
mixed  with  boric  acid,  is  a  still  better  plan  than  the 
application  of  a  wound  varnish.  The  powder  should  be 
held  against  the  wound  with  cotton.  As  bandages  are 
apt  to  bind  or  become  disarranged,  the  dressing  can 
be  renewed  every  second  day  without,  however,  disturb- 
ing the  sutures  or  the  powder  encrusted  around  them. 
The  redressing  amounts  to  a  renewal  of  the  powder 
that  falls  off  when  the  cotton  is  removed.  The  delicate 
fibers  that  will  eventually  mature  into  a  firm  union  of 
the  two  edges  are  not  to  be  disturbed  by  any  handling, 
for  if  these  are  once  broken  there  will  be  no  primary 
union,  even  if  there  is  no  infection. 

During  these  days  special  efforts  are  made  to  provide 
against  mechanical  injury  due  to  the  patient's  lying  upon 
the  wound  or  rubbing  it  against  the  stall,  or  from  move- 
ments of  the  limbs  and  body.  This  can  usually  be  done 
in  large  animals  by  simply  preventing  decumbency  for 
eight  days.  It  is  impossible  to  protect  a  wound  against 
the  strong  movements  of  a  horse's  getting  up  and  lying 
down,  no  matter  where  the  wound  is  located  about  the 
limbs  and  trunk. 

The  standing  position  for  horses,  and  strong  thick 
wraps  for  small  animals,  is  the  best  we  can  do  to  provide 
against  mechanical  injury. 

Between  the  seventh  and  the  tenth  days  the  sutures 
may  be  removed.  Sutures  that  are  doing  no  good  because 
of  having  cut  through  one  edge  should  be  removed  at 
once,  but  otherwise  hasty  removal  is  inadivsable.  Ten 
days  is  often  soon  enough  to  remove  sutures  of  the  skin 
over  the  large  muscles   (buttocks  and  shoulders).     At 


TREATMENT  OF  WOUNDS  95 

ten  days  the  wound  varnish  or  powder  used  to  protect 
the  wound  will  be  desquamating  and  can  easily  be  re- 
moved to  gain  a  good  view  of  the  sutures.  These  are 
removed  without  pulling  the  outside  dried  part  through 
the  needle  tract.  Lifted  from  the  surface  with  the  tissue 
forceps,  they  are  cut  with  the  scissors  and  then  pulled 
through  from  the  other  side. 

The  aseptic  incised  wound  is  now  healed.  It  requires 
no  further  attention.  What  a  goal  to  strive  for !  Y/hat 
a  reward  for  good  work !  And  what  a  wonder  it  is  not 
of  tener  sought !  To  find  a  wound  healed  when  the  sutures 
are  removed  is  a  good  surgeon's  pride.  To  have  them 
"kick  up"  is  a  nightmare — a  reflection  on  his  cautious- 
ness, his  skill,  or  even  his  knowledge. 

Wounds  with  Loss  of  Underlying  Tissues 

This  type  of  wounds,  that  can  be  bridged  over  with 
the  skin  and  whose  cavity  can  be  drained  by  gravitation 
of  the  discharges,  is  one  of  the  very  commonest  encoun- 
tered in  veterinary  practice.  It  is  much  more  common 
than  the  incised  wound  without  loss  of  substance.  This 
class  includes  the  wound  of  many  surgical  operations 
as  well  as  almost  all  of  the  accidental  traumata  sus- 
tained about  the  legs,  trunk,  neck,  and  head.  Whenever 
a  tumor  or  other  object  is  excavated  from  the  body  the 
surgeon  always  plans  to  bridge  the  excavation  over  with 
the  skin,  or  in  the  case  of  an  accidental  wound  it  is 
always  desirable  to  bring  the  skin  and  other  integuments 
into  apposition  over  the  underlying  cavity.  The  aim 
here  is  to  reduce  corporal  blemishing  to  the  minimum 
by  prompt  surface  healing,  and  to  avoid  the  dangers  of 
anaerobic  infections  by  keeping  (in  surgical  wounds) 
or  making  (in  accidental  wounds)  the  tissues  thus  cov- 
ered over  perfectly  aseptic. 


96  WOUND  TREATMENT 

This  wound  distinguishes  itself  therapeutically  from 
the  incised  wound  because  provision  must  be  made  for 
the  escape  of  the  serum  that  will  exude  from  its  walls, 
which  would  fill  up  the  cavity  to  the  physical  detriment 
of  the  healing  process  and  the  decided  advantage  of  in- 
vading microbes.  Even  though  a  wound  is  aseptic  it  must 
never  be  allowed  to  harbor  its  secretions  in  any  consider- 
able quantity.  Wounds  of  animals  filled  with  serum  be- 
come putrid  despite  everything. 

Treatment. — If  such  a  wound  is  surgical,  every  effort 
is  made  to  prevent  soiling  of  the  tissues  during  the  opera- 
tion. If  any  are  soiled  by  contact  with  dirt  or  flowing 
pus,  these  are  trimmed  off  with  the  scissors  or  scalpel 
rather  than  depending  upon  any  form  of  chemical  ablu- 
tion, the  aim  being  to  have  at  the  end  of  an  operation  a 
traumatic  cavity  that  is  absolutely  free  from  micro-organ- 
isms. The  surroundings  having  been  previously  shaved 
and  disinfected,  the  wound  is  now  ready  to  cover  over  by 
suturing.  An  opening  at  the  end  of  the  cavity,  or  a 
counter  opening  especially  made,  is  provided  for  the 
escape  of  the  serosity  that  will  exude  more  or  less 
copiously  during  the  succeeding  week.  If  the  orifice  thus 
provided  is  simply  kept  open  so  that  every  dram  of  the 
discharge  will  flow  out,  there  is  no  other  treatment  re- 
quired except  tha^t  of  maintaining  a  suitable  protection 
of  the  sutured  portion  against  external  contamination 
and  injury.  If  infection  of  the  cavity  is  prevented  dur- 
ing the  first  five  days  there  will  be  less  chance  for  any 
successful  invasion  of  microbes  thereafter.  That  is,  the 
first  few  days,  while  the  tissues  are  still  weakened  from 
the  injury  they  have  sustained  and  before  a  protective 
reaction  has  developed,  is  the  time  during  which  special 
care  must  be  taken  to  prevent  them  from  being  inocu- 
lated with  the  gauze,  the  syringe,  the  fingers,  or  any 
object  that  may  be  needed  to  keep  the  orifice  working 


TREATMENT  OF  WOUNDS  97 

as  a  draiu.  At  the  end  of  ten  days  the  sutures  may  be 
removed,  but  as  the  traumatic  cavity  will  require  another 
week,  or  even  a  fortnight,  to  cicatrize,  the  drainage  must 
be  continued.  In  wounds  whose  cavities  have  consider- 
able size  three  weeks  should  be  sufficient  time  to  heal 
them.  Infected  wounds  of  the  same  size  require  six  weeks 
to  two  months  or  even  longer  for  healing. 

The  accidental  wounds  of  this  class  interest  the  prac- 
titioner most.  They  include  almost  every  bodily  injury 
that  animals  sustain  accidentally  by  contact  with  objects 
capable  of  lacerating  the  skin  and  underlying  muscles. 
Kicks  on  the  buttocks,  the  thigh,  the  shoulder,  the  breast ; 
wire  cuts  in  the  heels,  the  forearm,  the  hock ;  and  almost 
all  manner  of  traumatism  from  collisions,  nearly  all 
belong  to  this  class. 

The  veterinarian  here  is  confronted  with  the  problem 
of  healing  up  an  ugly  wound  often  of  considerable  di- 
mensions, not  infrequently  invading  the  muscles  deeply — 
that  is,  bruised,  torn,  and  soiled.  The  desiderata  are  to 
heal  the  wound  quickly  and  to  leave  behind  as  little 
blemish  as  possible.  The  ugly  scars  that  mar  the  bodies 
of  so  many  splendid  horses  attest  the  poor  initial  treat- 
ment such  wounds  have  received. 

I  am  bearing  fully  in  mind  the  obstacles  that  con- 
front the  country  practitioner  arriving  on  the  scene  of 
such  an  accident.  The  patient  is  often  intractable,  the 
surroundings  are  not  inviting,  help  is  scarce,  and  last 
but  not  least  the  character  of  the  work  required  to  give 
the  wound  a  strictly  refined  treatment  is  not  compre- 
hended by  those  in  charge.  ' '  I  guess  you  had  better  sew 
it  up,  doc,"  is  the  usual  idea  of  the  treatment  required. 
There  is  seldom  any  conception  of  what  this  suggestion 
entails  if  followed  out  in  strict  accordance  with  the  rules 
of  modern  surgical  procedure. 

With   this   prevailing   notion   of   things   the    rent   is 


98  WOUND  TREATMENT 

usually  patched  up  with,  needle  and  thread  after  a  per- 
functory ablution  with  an  antiseptic  solution.  Four  days 
later  it  is  an  open  wound  again,  more  seriously  and  more 
deeply  infected  than  if  it  had  been  left  entirely  to  the 
mercies  of  nature.  To  change  this  order  of  affairs  is  now 
our  serious  duty,  and  in  view  of  the  fact  that  it  is  exceed- 
ingly easy  to  show  the  difference  between  good  wound 
treatment  and  poor  wound  treatment  the  objection  to  put- 
ting a  stiff  initial  cost  on  the  treatment  of  such  a  wound 
will  not  be  long  lived.  We  have  done  it  in  a  city  prac- 
tice and  I  am  sure  the  country  practitioner  can  do 
likewise. 

Formerly  we  treated  accidental  wounds  of  all  kinds, 
except  enormous  ones,  in  the  stables.  Wle  secured  the 
patient  with  the  twitch  and  sideline,  washed  the  wound, 
sewed  it  up  after  more  or  less  of  a  running  fight  with 
the  patient,  and  then  applied  whatever  protection  best 
suited.  In  the  usual  four  or  five  days  we  were  always 
called  again  to  do  the  work  over.  "The  stitches  have 
broken  out, ' '  was  the  usual  cry.  Sometimes  a  second  at- 
tempt at  closure  was  made,  but  more  often  the  dangling 
skin  was  trimmed  and  open-wound  treatment  applied 
during  the  remaining  long  process  of  cicatrization.  In 
such  cases  there  was  the  cost  of  the  first  treatment;  of  a 
number  of  periodical  visits  during  the  succeeding  six 
weeks ;  of  antiseptic  lotions,  astringent  lotions,  and  pow- 
ders, without  accounting  for  the  costly  days  of  disability. 

To-day  we  bring  such  patients  to  the  hospital,  devote 
two  or  three  hours  to  the  initial  treatment,  keep  the 
patient  in  the  hospital  eight  days,  and  usually  return  it 
to  work  at  the  end  of  two  weeks,  or  in  three  in  cases  of 
extensive  wounds.  In  the  former  cases  the  scar  was  large, 
indelible,  conspicuous;  in  the  latter  there  is  often  no 
plain  evidence  that  a  wound  has  ever  existed.  The  cost 
to  the  client  is  about  the  same  in  both  cases,  but  in  the 


TREATMENT  OF  WOUNDS  99 

latter  the  money  is  earned  by  skill  while  in  the  former 
it  was  not  earned  at  all;  the  patient  would  have  been 
about  as  well  off  without  any  expert  (?)  interference; 
common  everyday  home  treatment  would  have  done  just 
as  well.  In  the  former  the  patients  were  marred  for 
life,  while  in  the  latter  their  full  value  is  restored.  In  the 
former  the  patients  were  disabled  two  months,  in  the 
latter  two  to  three  weeks.  Our  plan  of  handling  acci- 
dental wounds  of  the  body  is  as  follows: 

1.  Restraint. — Even  tractable  patients  always  put  up 
a  pretty  vigorous  opposition  against  interference  with  a 
wound  recently  inflicted.  They  especially  object  to  the 
suturing,  and  as  wounds  are  often  located  where  there 
is  danger  of  the  veterinarian  sustaining  personal  injury, 
it  is  difficult  and  tedious  to  carry  out  the  treatment 
without  some  form  of  effectual  control.  Much  the  best 
plan  is  to  use  the  operating  table.  Removal  to  the  hos- 
pital should  be  insisted  upon  where  the  distance  is  not 
too  great.  Here  the  patient  will  be  well  controlled  and 
well  positioned  to  carry  out  every  detail  from  beginning 
to  end.  For  outdoor  work  the  standing  position  will  be 
found  better  than  casting  harnesses.  In  the  latter 
almost  every  wound  is  in  an  awkward  position  near  the 
ground,  difficult  of  access  and  in  tiresome  position  for 
the  operator  to  work  so  long.  Some  form  of  improvised 
stocks  to  keep  the  patient  from  lunging  about,  supple-, 
mented  with  a  sideline  or  breeding  hopples,  may  be  made 
to  answer  the  purpose.  Then  the  operation  may  be  made 
less  painful  by  wiping  the  internal  surface  of  the  skin 
with  tAvo-per-cent  cocain  solution  as  far  from  the  edges 
as  the  needle  points  will  be  located.  This  will  greatly 
but  not  entirely  control  the  pain  of  suturing.  This  same 
form  of  anesthesia  may  also  be  used  when  the  patient  is 
secured  on  the  operating  table.  It  prevents  annoying 
struggles  which  raise  dust  and  otherwise  interfere  with 


100  WOUND  TREATMENT 

the  work.  Respiratory  anesthesia  is  not  applicable  be- 
cause the  operation  is  of  too  long  duration. 

For  wounds  on  the  legs  we  have  found  the  casting  har- 
ness better  than  the  standing  position  because  the  legs 
are  never  well  immobilized  standing,  and  the  surgeon 
is  forced  into  a  very  uncomfortable  bending  position,  par- 
ticularly if  the  wound  is  about  or  below  the  knees  or 
hocks. 

In  every  form  of  recumbent  restraint  some  care  must 
always  be  exercised  in  letting  the  patient  up  without 
inflicting  violence  to  the  sutured  wound.  The  forcible 
movements  of  the  legs  may  stretch  a  sutured  wound  wide 
open  by  tearing  either  the  sutures  or  the  skin  in  which 
they  are  inserted.  In  taking  from  the  operating  table 
a  horse  that  has  just  been  sutured  about  the  buttock,  or 
which  has  been  operated  for  shoe  boil,  we  always  keep 
the  foot  of  the  affected  leg  in  the  hopple  until  it  lands 
safely  to  the  floor  and  supports  weight.  Otherwise  a 
swing  might  do  much  harm.  For  wounds  of  the  legs 
treated  in  the  casting  harness  ample  protection  can  al- 
ways be  given  against  such  injury  by  using  plenty  of 
bandaging  material,  and  by  helping  the  patient  promptly 
to  its  feet  without  unnecessary  struggles. 

2.  Disinfection. — We  always  try  to  begin  this  part  of 
the  treatment  before  securing  the  animal,  by  giving  the 
body  a  thorough  cleaning.  Dried  mud  on  the  legs, 
feathers,  and  abdomen  must  always  be  curried  and 
brushed  off.  Otherwise  a  veritable  halo  of  dust  will 
cloud  the  whole  atmosphere  when  the  patjent  is  strug- 
gling during  the  operation.  A  good  brushing  and  then 
a  wiping  of  the  whole  body  with  a  w^et  towel  are  essen- 
tial. A  preoperative  bath  where  there  are  accommo- 
dations for  such  treatment  would  of  course  be  better,  but 
as  animal  bathrooms  are  not  usually  available,  the  above 
method  of  cleaning  must  answer  the  purpose. 


TREATMENT  OF  WOUNDS  101 

The  patient  once  secured,  the  first  step  is  to  shave  the 
region  about  the  wound.  A  good  liberal  field  is  shaved, 
not  merely  a  narrow  strip  along  the  edges.  As  shaving 
requires  previous  washing  of  the  hairs  to  soften  them, 
the  wound  itself  will  become  additionally  soiled  in  this 
process  by  the  lather  and  hairs  falling  into  it,  but  as 
subsequent  treatment  will  attend  to  this,  little  harm  will 
be  done.  It  is,  however,  not  advisable  to  be  unduly  care- 
less in  this  matter.  By  shaving  first  a  narrow  strip  ajong 
the  margin,  drawing  the  razor  away  from  the  edge,  much 
of  this  hair-soiling  may  be  avoided.  Hair-soiling  can 
also  be  prevented  somewhat  by  wadding  the  cavity  with 
cotton  while  the  shaving  is  being  done. 

In  a  large  wound  this  shaving  is  no  small  undertaking, 
but  in  no  case  must  it  be  omitted  or  slighted  on  that 
account. 

The  next  step  is  to  disinfect  the  shaved  skin.  Brisk 
friction  with  mercuric  chlorid  solution  (1  part  to  500  of 
sterile  water)  comes  first,  then  it  is  painted  with  tincture 
of  iodin,  or,  w^hat  is  still  better,  a  solution  of  iodin  crystals 
in  ether.  Two  drams  of  iodin  to  one  pound  of  ether  is 
the  solution  we  are  now  using  for  skin  disinfection.  It 
seems  to  assure  a  better  skin  disinfection  than  does  the 
alcoholic  solution.  It  penetrates  into  the  recesses  of  the 
skin  better  than  the  tincture,  and  thus  effects  a  deeper 
disinfection. 

The  surroundings  having  been  thus  prepared,  atten- 
tion is  now  directed  to  the  raw  tissues.  Here  we  find 
torn  muscle  tissue,  shreds  of  fascia,  nerves,  vessels,  sub- 
cutaneous areolar  tissue,  all  more  or  less  soiled.  Every 
part  of  this  motley  surface  is  infected  and  there  is  no 
way  of  disinfecting  it  Avith  chemicals  if  the  wound  must 
be  closed.  Strong  disinfecting  chemical  substances  that 
would  be  capable  of  killing  the  microbes  now  harbored  on 
and  within  this  anfractuous  surface  would  also  cauterize 


102  WOUND  TEEATMENT 

it  and  thus  produce  a  lot  of  debris  that  would  have  to 
be  cast  off  by  the  healthy  elements  beneath.  Such  treat- 
ment is  of  course  out  of  reason  where  the  cavity  must  be 
bridged  over  with  the  skin.  Ordinary  antiseptic  ablu- 
tions are  inadequate;  they  never  actually  disinfect  any- 
thing. Every  attempt  we  have  ever  made  to  bring  this 
surface  of  wounds  into  a  safe  state  for  suturing  with  so- 
lutions has  ended  in  disappointment.  Disastrous  suppu- 
ration ensued  and  primary  union  of  the  skin  was  pre- 
vented in  every  case.  So  uniform  was  this  result  that 
we,  like  many  others,  fell  back  on  open-wound  treatment 
for  a  time  as  much  the  best  and  safest  plan  of  treating 
practically  all  accidental  wounds.  It  gave  better  results 
than  the  closing  of  wounds  that  were  harboring  infected 
tissues  beneath  the  sutured  integument.  For  a  long  time 
we  only  sutured  accidental  wounds  for  policy's  sake — to 
appease  a  request — knowing  all  the  while  it  was  a  use- 
less procedure,  and  we  always  prepared  for  the  inevi- 
table breaking  open  a  few  days  later,  at  which  time  the 
real  treatment  of  the  wound  began. 

We  are  now  submitting  such  wounds  to  a  mechanical 
disinfection  we  have  called  "uncarpeting."  That  is,  we 
trim  off  all  of  the  surface  sheet-like,  beginning  above  and 
omitting  nothing  save  possibly  a  synovial  capsule,  large 
blood  vessel,  or  an  important  nerve.  These  are,  how- 
ever, seldom  encountered  in  wounds  of  this  class.  A 
sharp  scalpel,  scissors,  and  tissue  forceps  are  used,  and 
as  the  surface  is  loosened,  the  loose  pieces  are  washed 
off  by  a  stream  of  sterilized  water  poured  from  a  pitcher 
by  an  assistant.  The  edges  of  the  skin  must  be  turned  up 
where  it  is  loosened  from  the  body  and  its  under  surface 
submitted  to  the  same  trimming.  Where  there  is  nothing 
loose  to  trim  off,  the  wound  is  scraped  with  the  scalpel 
as  the  stream  of  water  washes  off  the  scrapings.  The 
edges  of  the  skin  must  be  included.     Sometimes  simply 


TREATMENT  OF  WOUNDS  103 

scraping  them,  at  other  times  trimming  them  straight 
with  the  scissors,  may  be  thought  best,  depending  upon 
their  condition. 

A  wound  thus  mechanically  disinfected  is  a  pure 
wound,  as  aseptic  as  a  wound  of  the  surgeon's  own  mak- 
ing, and  it  has  a  large,  clean,  disinfected  field  around  it. 
In  short,  it  is  a  fit  wound  to  close  up,  and  if  closed  prop- 
erly it  will  behave  in  the  manner  that  will  please. 

The  wound  cavity,  having  thus  been  ridden  of  all 
microbe-laden  tissues,  is  a  safe  cavity  to  bridge  over  with 
the  skin,  but  to  prevent  subsequent  contamination  provi- 
sions must  be  made  to  prevent  accumulation  of  the  serum 
that  will  exude  from  the  walls.  That  is,  the  cavity  must 
be  drained.  Serum  must  not  be  allowed  to  remain  even 
momentarily  in  a  wound  cavity,  for  if  this  microbe  food 
is  offered,  putrefaction  of  the  serum,  followed  by  infec- 
tion of  the  living  walls,  is  sure  to  follow.  The  certainty 
with  which  microbes  creep  into  favorable  places  for  their 
growth  is  now  well  known  to  students  of  aseptic  surgery 
The  favorable  environment  is  as  certain  a  source  of  in- 
fection as  manual  soiling.  Mutilated,  bruised,  weakened 
tissues  are  prey  for  microbes,  and  when  these  are  soaked 
in  a  serosity  a  few  otherwise  innocuous  organisms  may 
soon  develop  a  formidable  infection,  while  strong  and 
only  slightly  injured  tissues  would  destroy  them.  Id 
short,  when  we  create  a  favorable  medium  and  an  incu- 
bator, the  microbes  are  usually  there  to  do  mischief, 
while  on  the  other  hand  if  we  create  unfavorable  soils 
for  microbian  growth  infections  become  negligible. 
These  are  laws  in  wound  treatment,  and  they  must  be 
obeyed  as  sacredly  as  the  laws  relating  to  the  sterilization 
of  infection  carriers,  bands,  instruments,  and  so  on. 
Whether  these  infections  of  bruised  wounds  are  endoge- 
nous or  exogenous  is  less  important  to  the  practitioner 


104  WOUND  TREATMENT 

than  the  fact  that  they  are  very  certain  to  occur  in  a 
large  percentage  of  cases. 

To  better  illustrate  this  point,  the  prevailing  contro- 
versy in  the  medical  profession  over  the  open  treatment 
of  fractures  might  be  mentioned  to  advantage.  During 
the  last  few  years  the  old,  time-honored  method  of  treat- 
ing fractures  of  long  bones  by  simple  reposition  and 
retention  has  been  discarded  by  many  surgeons  for  the 
new  open  method.  That  is,  an  invading  incision  was 
made  into  the  traumatic  cavity  and  the  segments  fitted 
together  and  retained  with  screws,  nails,  or  plates.  With 
asepsis  as  a  protection  against  complications,  it  at  first 
seemed  this  apparently  sensible  method  would  soon  be- 
come the  universal  one  for  the  treatment  of  fractures. 
Subsequent  developments,  however,  proved  that  the  plan 
was  not  entirely  harmless.  Many  cases  became  infected 
with  disastrous  results.  Why?  Because  a  fracture  with 
its  injured  tissues,  blood-clots,  outpoured  serum,  and  im- 
paired circulation  is  a  favorable  field  for  infection. 
To-day,  on  this  account  alone,  the  open  method  is  being 
abandoned  except  in  special  cases.  In  veterinary  prac- 
tice the  wound  of  castration  might  be  used  to  illustrate 
the  same  point.  The  crushed  spermatic  cord,  the  accumu- 
lated clot  and  serum,  and  the  closed  incision  combine 
conditions  especially  favorable  for  microbian  growth.  In 
fact,  if  any  bacteria  are  deposited  they  are  prone  to 
develop  a  serious  infection  very  rapidly. 

We  must,  therefore,  plan  as  perfect  a  system  of  drain- 
age as  possible  in  all  wounds  of  this  class,  for  otherwise 
our  other  good  work  will  be  useless.  During  the  trim- 
ming process — that  is,  the  mechanical  disinfection  re- 
ferred to  in  the  preceding  paragraph — special  care  is 
taken  to  groove  channels  toward  the  proposed  drainage 
orifice.    This  done,  the  skin  flap  is  ready  to  be  sutured. 


TREATMENT  OF  WOUNDS  105 

Suturing  the  Skin  Flap 

At  this  stage  of  the  procedure  the  veterinarian  should 
don  a  pair  of  sterilized  skin-tight  gloves  or  else  handle 
needle  and  thread  with  the  needle-holder,  with  the  aid  of 
an  assistant  to  keep  the  dangling  end  from  trailing 
about  over  soiled  places.  The  former  method — the  wear- 
ing of  gloves — is  the  better,  because  suturing  can  then 
be  done  much  faster  and  also  more  accurately.  The  first 
effort  is  to  baste  the  flap  with  crucial  sutures  arranged 
somewhat  loosely  and  about  one  inch  apart,  some  care 
being  taken  to  bring  the  flap  to  the  place  it  actually 
belongs  in  order  to  prevent  wrinkling  and  to  avoid  ten- 
sion. This  basting  process  is  of  great  importance,  be- 
cause if  it  is  w^ell  done  the  rest  is  a  mere  routine.  The 
edges  themselves  are  not  yet  approximated;  there  is  a 
gap  along  the  entire  flap.  An  accurate  approximation  is 
now  effected  with  interrupted  sutures  placed  one  quarter 
of  an  inch  apart  and  about  three  sixteenths  of  an  inch 
from  the  edges.  Every  fourth  or  fifth  stitch  of  these 
interrupted  sutures  is  made  longer — about  a  quarter  of 
an  inch  from  the  edges,  or  even  more.  The  latter  sutures 
are  retaining  sutures,  like  the  crucial  sutures,  while  the 
short  ones  are  the  real  approximating  media.  The  short 
sutures  tend  to  prevent  the  infolding  of  edges  that  is  sure 
to  be  produced  by  the  longer  ones.  Infolding  of  the 
edges  must  be  corrected  at  every  point,  as  union  is  impos- 
sible unless  the  raw  edges  are  brought  into  contact. 
Every  part  is  thus  closed  up  except  the  place  planned 
for  the  drainage  orifice.  The  size  of  the  orifice  or  counter 
opening  specially  made  must  harmonize  with  the  size  of 
the  traumatic  cavity.  A  large  wound  will  require  a 
larger  opening  than  a  small  wound,  because  a  free  outlet 
is  essential. 


106  WOUND  TREATMENT 

In  the  short,  interrupted  sutures,  which  only  pinch  up 
the  very  edges  of  the  skin,  lies  the  secret  of  success.  The 
greatest  error  of  suturing  wounds  of  animals  seems  to 
have  been  that  of  putting  in  long  interrupted  sutures. 
These  prevent  union  by  blocking  the  circulation,  while 
the  short  sutures,  which  pick  up  only  little  bits  of  skin, 
permit  the  circulation  of  the  blood  freely  to  the  very 
edges,  where  it  is  most  needed. 

The  wound  is  now  well  repaired,  and  the  skin  flap  is 
neatly  approximated  to  the  other  edge  of  the  wound  with- 
out stretching.  That  is,  there  is  no  strain  on  the  flap; 
it  lies  comfortably  in  the  place  where  it  properly  belongs. 
There  is,  however,  still  some  danger  of  damage  from 
movements  of  the  underlying  muscles,  despite  this  perfect 
apposition  of  the  edges  of  the  skin.  This  danger  we  re- 
duce to  the  minimum  by  fixing  the  skin  down  to  the 
body  with  Mayo 's  running  loop,  put  in  from  one  to  three 
inches  apart,  according  to  the  amount  of  strain  to  which 
the  flap  will  be  subjected  by  movements  and  edema.  On 
prominent  convexities  of  the  body,  such  as  buttocks  or 
shoulder,  there  will  be  more  strain  than  in  flat  places  like 
the  forehead  or  costal  surface.  In  the  former  these  loop 
sutures  are  placed  close  together ;  in  the  latter,  they  may 
not  be  needed  at  all.  It  is  our  judgment  after  several 
years  of  trial,  in  many  wounds  treated,  that  the  resort 
to  the  use  of  Mayo's  running  loop  is  the  greatest  boon 
to  wound  suturing  in  animals.  Without  them  we  have 
failed  even  when  everything  else  was  done  well  and  con- 
ditions were  favorable.  Since  resorting  to  them  we  sel- 
dom fail  to  heal  these  wounds  promptly. 

For  those  readers  who  are  not  acquainted  with  this 
special  suture,  and  especially  for  those  who  have  no  access 
to  literature  in  which  it  is  described,  the  following  de- 
scription is  given: 

"Mayo's  running  loop"  is  a  series  of  continuous  loops 


TREATMENT  OF  WOUNDS  107 

that  cross  the  wound  line  at  a  right  angle.  They  are 
made  to  extend  from  about  three  inches  on  one  side  to 
about  the  same  distance  on  the  other.  A  full  curved 
needle  is  armed  with  about  two  feet  of  single  thread.  Be- 
ginning say  three  inches  from  the  wound  line,  the 
needle  is  passed  subcutaneously  or  even  deeper  toward 
the  wound,  coming  out  three  quarters  of  an  inch  from 
the  point  of  entrance.  One  foot  of  the  thread  is  drawn 
through.  The  dangling  end  is  then  tied  with  a  double 
knot  at  the  exit  point,  the  knot  lying  upon  the  hole. 
Letting  the  end  dangle  again,  the  needle  is  now  in- 
serted through  the  exit  point  and  brought  out  again 
three  quarters  of  an  inch  toward  the  wound,  where 
the  dangling  end  is  again  tied  in  the  same  way.  These 
are  continued  across  the  wound  to  about  the  same  dis- 
tance on  the  opposite  side.  The  loops  are  not  tied  tight 
enough  to  block  circulation  but  just  tight  enough  to 
lie  straight.  When  one  is  completed  another  is  put  in, 
one,  two,  or  three  inches  away,  and  so  on,  until  the  whole 
field  of  skin  is  firmly  recarpeted  to  the  body. 

It  is  almost  a  physical  impossibility  for  a  skin  flap  so 
fixed  to  break  away  from  the  body.  Even  when  active 
inflammation  follows,  the  flap  stays  fixed. 

The  drainage  orifice,  provided  by  leaving  a  dependent 
part  unsewed  or  by  making  a  counter-opening,  is  now 
wadded  with  an  aseptic  gauze  wick.  The  first  wadding 
should  be  tight  so  as  to  dilate  the  orifice.  Subsequent 
waddings  must  be  more  loosely  arranged  to  allow  outflow 
of  discharges. 

We  now  "touch  up"  the  sutures  along  the  wound 
with  tincture  of  iodin  and  then  varnish  the  whole  field 
with^four  or  five  successive  layers  of  collodion.  These 
thick  applications  of  collodion  play  an  important  role  in 
supporting  the  sutures,  and  they  also  afford  a  perfect 
cloak  to  keep  out  external  soiling. 


108  WOUND  TREATMENT 

The  patient  must  now  be  placed  under  restraint  that 
will  protect  the  wound  against  injury.  Standing  for 
ten  days  is  always  a  part  of  this  restraint,  as  there  is  no 
way  to  prevent  stretching,  tearing,  and  bruising  a  wound 
if  the  patient  is  allowed  freedom.  If  the  wound  is  lo- 
cated around  the  hips,  thighs,  hocks,  buttocks,  or  croup, 
switching  the  tail  must  be  prevented  by  sacking  or  tying 
it  to  one  side.  For  wounds  about  the  forequarters, 
neck,  or  head,  it  is  best  to  back  the  patient  into  a  single 
stall,  fasten  the  head  on  the  pillar  reins,  and  feed  from  a 
hammock.  Slings  may  sometimes  be  thought  necessary 
to  assure  the  desired  state  of  repose  that  makes  for  good 
healing. 

The  after-care  of  the  wound  consists  of  daily  attention 
to  the  orifice.  This  must  be  kept  from  damming  up  the 
discharges.  A  loose  wick  pushed  up  two  or  three  inches 
is  the  best  way  to  keep  the  drain  working  well. 

At  the  end  of  ten  days  the  collodion  will  be  shedding. 
It  will  be  found  adherent  here  and  there,  but  easy  enough 
to  remove  by  passing  blunt  scissors  beneath  it.  The 
sutures  are  now  removed  along  the  edges,  and  if  it  is 
found  there  are  some  places  not  united,  the  loops  are 
not  disturbed  for  several  days  more. 

If  there  is  any  doubt  about  the  firmness  of  the  union 
the  patient  must  be  kept  in  the  standing  position  until 
the  danger  of  breaking  open  the  wound  has  passed.  In 
twenty  days  such  a  patient  is  usually  ready  for  the  har- 
ness. A  longer  time  may,  however,  be  required  where 
the  traumatic  cavity  was  large  or  when  the  wound  is 
located  at  a  flexion  surface. 

The  reader  might  also  be  reminded  that  the  treatment 
of  such  a  wound  is  never  complete  without  the  adminis- 
tration of  an  immunizing  dose  of  antitetanic  serum.  The 
closing  up  of  a  wound  of  this  character  creates  a  tetano- 
genic  field,  and  as  this  certain  preventive  is  available, 


TREATMENT  OF  WOUNDS  109 

we   are   not  justified  in   depending   entirely   upon   our 
mechanical  disinfection  to  prevent  tetanus. 

Wounds  That  Cannot  Be  Drained  by  Gravitation  of 
the  Discharges — Open  Wounds 

This  group  includes  both  the  surgical  and  the  acciden- 
tal wounds  located  at  the  summit  of  a  region.  The  trau- 
matic cavity  points  upward  and  its  bottom  is  too  far 
from  the  surface  of  the  body  to  drain  downward.  It 
includes  the  surgical  wound  of  radical  poll-evil  opera- 
tions and  some  operations  for  fistula  of  the  withers,  quit- 
tors,  and  all  the  accidental  wounds  of  the  back,  loins, 
croup,  and  heels.  Almost  all  other  w^ounds  besides  these 
can  be  drained  and  treated  by  the  method  previously 
described.  The  surgical  wounds  of  this  kind  are  often 
invasions  of  badly  infected  places,  but  the  aim  of  the 
operation  in  each  case  is  to  remove  en  masse  the  microbe- 
laden  structures. 

Thus  in  poll  evil,  although  we  start  wdth  a  badly 
infected  mass  of  tissue  and  tracts  carpeted  with  infected 
granulations,  when  the  operation  is  properly  done  all  of 
these  are  safely  removed  and  the  cavity  resulting,  if  not 
entirely  sterile,  is  in  a  fairly  good  state  for  the  easy 
destruction  of  the  infection  that  remains.  The  same 
may  be  said  of  all  operations  of  this  character.  The 
operation  Jtself  is  the  mechanical  disinfection  needed  to 
promote  healing,  and  the  performance  of  the  operations 
must  be  carried  out  with  this  end  in  view,  for  if  we  leave 
our  surgical  wounds,  made  in  infected  structures,  with- 
out disposing  of  the  original  infection,  or  deposit  more 
in  operating,  these  wounds  will  be  difficult  to  manage. 
They  will  heal  slowly.  The  fact  that  we  are  operating 
upon  infected  structures  is  never  an  excuse  for  unclean 
surgery.     These  operations  should  be  as  clean  as  those 


110  WOUND  TREATMENT 

made  in  perfectly  sound  flesh,  and  in  working  through 
such  operation  we  should  keep  in  mind  that  the  desired 
goal  is  to  leave  at  the  completion  of  the  operation  an 
aseptic  traumatic  cavity.  With  this  accomplished,  the 
subsequent  management  consists  of  disposing  of  the  dis- 
charges which  gather  in  the  cup-like  cavity  as  fast  as 
they  accumulate.  What  gravitation  does  in  the  wound 
previously  described,  we  must  now  do  by  absorption. 
A  large  traumatic  cavity  will  pour  out  an  enormous 
amount  of  serosity  between  the  second  and  fifth  days. 
To  dispose  of  this  accumulation  during  these  days  is 
the  prime  factor  in  the  treatment  of  such  wounds,  and 
as  the  healing  period  will  be  materially  shortened  if 
infection  is  controlled  it  is  well  worth  while  to  work  dili- 
gently at  the  task  of  absorbing  discharges  during  this 
period — the  first  five  days.  Thereafter,  as  the  exuda- 
tion will  gradually  diminish  and  the  walls  will  have  pro- 
tected themselves  against  invasion,  this  diligence  may  be 
somewhat  relaxed.  It  is,  however,  well  to  keep  all  wound 
cavities  as  dry  as  possible  until  they  are  level. 

The  best  method  we  have  found  to  take  care  of  dis- 
charges in  large  cavities  is  by  smothering  them  with  boric 
acid  and  iodoform  (95  to  5  per  cent) .  The  cavity  is  filled 
with  this  powder,  and  it  is  renewed  three  times  a  day 
if  it  becomes  soaked.  While  this  vigilance  may  seem  tt) 
be  considerable  trouble,  it  is  always  rewarded  by  prompt 
healing,  and  is  much  less  trouble  than  that  almost  im- 
possible task  of  handling  the  copious  flow  of  pus  over 
the  surface  of  the  body,  sometimes  encrusted  an  inch 
thick  from  withers  to  heels,  constituting  about  the  most 
unsavory  postoperative  condition  imaginable.  The  diffi- 
culty in  handling  this  latter  condition  is  enormous  com- 
pared with  the  little  trouble  necessary  to  prevent  occur- 
rence by  diligent,  initial  attention,  lasting  four  to  five 
days.     Furthermore,   traumatic  cavities  of  this  nature 


TREATMENT  OF  WOUNDS  111 

that  are  not  allowed  to  become  infected,  never  overfill 
with,  exuberant  granulations — when  the  cavity  is  filled 
the  granulations  are  already  maturing  into  firm  tissue. 

The  use  of  gauze  for  the  purpose  of  absorbing  secre- 
tions in  wounds  that  cannot  drain  has  not  given  us  the 
same  satisfaction  as  the  absorbent  powder  above  men- 
tioned, and  is  applicable  only  in  small  wounds  and  espe- 
cially in  wounds  of  small  animals. 

Boric  acid  will  take  up  large  quantities  of  wound 
discharges  and  may  be  depended  upon  to  preserve  from 
putrefaction  any  serum  it  thus  absorbs,  while  iodoform, 
kept  continuously  in  contact  with  the  walls  of  a  wound 
cavity,  will  disinfect  them  better  than  any  other  known 
chemical.  i 

In  accidental  wounds  of  this  group  the  practitioner 
should .  choose  one  of  two  lines  of  treatment.  The  first 
begins  with  mechanical  disinfection  as  described  for 
wounds  preparatory  to  closure  and  is  followed  up  by 
keeping  the  wound  aseptic  with  boric  acid  and  iodo- 
form while  the  cavity  is  filling  up.  If  the  granulations 
threaten  to  overgrow,  there  is  nothing  better  to  control 
them  than  plain  white  lotion. 

The  second  method  begins  with  a  disinfection  with  a 
strong  chemical  substance  that  will  not  only  destroy  the 
microbes  but  will  also  cauterize  the  tissues  into  a  firm 
protective  coating  of  dead  elements.  Both  of  these  plans 
are  good  because  each  first  disposes  of  the  surface  infec- 
tions that  would  soon  do  mischief.  The  former  is  the 
more  refined,  the  latter  the  more  practicable  for  veteri- 
narians. Whenever  a  veterinarian  cannot  or  will  not 
for  any  reason  surgically  disinfect  an  accidental  wound 
that  he  decides  to  treat  as  an  open  one,  he  should  apply 
to  it  a  chemical  substance  that  will  do  something  and 
not  merely  delude  himself  into  believing  that  any  ordi- 
nary antiseptic  wash  will  be  of  material  benefit.    Strong 


112  WOUND  TREATMENT 

proprietary  liniments  often  gain  wide  reputations  as 
wound  medicines  because  they  are  actually  germicides. 
The  fact  that  they  temporarily  retard  healing  by  cauter- 
izing the  surface  is  in  their  favor  because  they  destroy 
everything  they  touch,  and  because  they  produce  a  leath- 
ery coating  that  gives  protection  against  subsequent  in- 
fection. Wounds  thus  treated  escape  the  surrounding 
phlegmonous  condition  of  infection,  and  when  the  eschar 
desquamates,  the  cavity  is  found  paved  with  a  layer  of 
rosy,  healthy  granulations  that  need  but  little  further 
attention  beyond  a  weak  antiseptic  powder  or  mild 
astringent. 

What  chemical  substance  should  the  veterinary  prac- 
titioner select  for  this  purpose?  In  other  words,  what 
is  the  best  application  for  an  open  wound?  Pure 
phenol,  butter  of  antimony,  and  chemically  pure  nitro- 
hydrochloric  acid  are  strong  substances  to  consider  in 
this  connection,  but  they  are  exactly  the  kind  of  chem- 
ical to  use.  Applied  with  a  brush,  with  precautions 
against  overflow,  these  substances  will  do  no  harm.  A 
little  discretion  to  avoid  the  cauterization  of  synovials, 
nerves,  and  large  blood  vessels  should  of  course  be  prac- 
ticed in  the  use  of  such  radical  measures,  just  as  the 
surgeon  would  avoid  cutting  these  with  the  scalpel. 

A  good  lotion,  less  potent  than  the  above  but  one  that 
will,  however,  answer  the  purpose,  consists  of  one  ounce 
of  permanganate  of  potash  and  two  ounces  of  sulphate  of 
zinc,  dissolved  in  a  quart  of  water.  This  can  be  applied 
two  or  three  times  daily  until  perfect  disinfection  is 
assured,  or  a  wad  of  cotton,  soaked  in  the  solution,  may 
be  bound  to  the  wound  and  renewed  frequently. 

Kerosene  is  a  mighty  good  disinfectant  of  raw  sur- 
faces if  applied  frequently  during  the  first  few  days, 
and  it  is  perfectly  safe  if  it  does  not  touch  the  skin. 

In  fine,  open-wound  treatment  must  begin  with  disin- 


TREATMENT  OF  WOUNDS  113 

fectiou  of  the  exposed  raw  tissues.  If  this  is  not  done 
surgicall}',  in  the  manner  prescribed  for  mechanical  dis- 
infection, then  let  the  veterinarian  throw  precedent  to 
the  winds  and  "go  at"  his  wounds  with  chemicals  that 
will  do  this  work  for  him. 

Venomous  Wounds 

This  term  is  coined  to  meet  the  requirements  of  the 
particular  scheme  of  treatment  already  laid  down  in  the 
preceding  paragraphs.  By  it  we  wish  to  distinguish 
wounds  in  the  active  stage  of  inflammation.  A  venom- 
ous wound  is  one  invaded  with  bacteria  and  envenomed 
with  their  toxins.  The  term  "infected  wound"  is  some- 
what different,  since  a  wound  is  infected  as  soon  as  bac- 
teria have  lodged  upon  it;  it  is,  however,  not  envenomed 
until  these  bacteria  have  injected  it  with  their  poisons. 
The  term  is  used  to  designate  that  period  of  infection 
intervening  between  the  time  the  tissues  begin  to  react 
against  the  bacteria  and  their  poisons  and  the  final  cessa- 
tion of  the  active  inflammation.  In  short,  it  applies  to 
all  wounds  in  the  siege  of  active  inflammatory  processes. 
When  the  inflammation  subsides,  cicatrization  proceeds 
normally,  unless  there  is  some  permanent  damage  done 
to  a  bone,  a  tendon,  a  ligament,  a  cartilage,  or  an  un- 
drained  cavity  has  formed.  These  events  may  cause  a 
chronic  suppurative  process — a  fistula.  When  the  active 
inflammation  ceases,  or  a  chronic  state  of  suppuration 
supervenes,  the  term  "venomous  wound"  no  longer 
applies. 

When  a  wound  is  soiled  (infected)  and  before  there 
is  any  inflammation — that  is,  during  the  first  twenty- 
four  or  even  forty-eight  hours — we  have  recommended 
the  unceremonious  trimming  off  of  the  bacteria-laden 
tissues.  That  is,  we  have  advised  the  immediate  crea- 
tion of  an  aseptic  wound  from  a  badly  contaminated 


114  WOUND  TREATMENT 

one.  To  resort  to  the  same  measures  in  a  venomous 
wound  would  be  an  error  fraught  with  much  havoc. 
Surgical  interference  with  a  wound  in  the  active  stage  of 
inflammation  (a  venomous  wound)  is  capable  of  doing 
harm  by  opening  up  new  channels  for  invasion  and  thus 
exciting  rather  than  subduing  the  inflammatory  process. 
The  mechanical  disinfection  —  uncarpeting  —  previously 
referred  to  for  soiled  wounds  is  not  recommended  in  the 
treatment  of  venomous  wounds.  When  bacteria  have 
already  injected  the  tissues  with  poisons  and  have  them- 
selves invaded  more  or  less  deeply  into  the  tissues,  me- 
chanical disinfection  is  no  longer  indicated.  That  is  to 
say,  when  a  wound  already  shows  a  pronounced  local 
reaction  of  swelling,  pain,  redness  and  probably  a  sys- 
temic febrile  reaction,  it  is  too  late  to  transform  it  at 
once  into  an  aseptic  wound.  We  must  now  manage  it  in 
another  manner.  Radical  extirpation  or  amputation 
may  be  called  for  when  a  venomous  wound  actually 
threatens  life,  but  such  measures  are  rarely  expedient 
in  animal  surgery. 

The  evacuation  of  purulent  collections,  from  the  hot- 
bed of  the  infected  center,  and  the  trimming  off  of  ele- 
ments actually  dead,  are  the  only  surgical  treatments 
to  which  a  venomous  wound  should  be  submitted,  and 
these  measures  should  be  carried  out  carefully  so  as  to 
inflict  as  little  injury  to  the  inflammatory  surroundings 
as  possible.  If  we  meddle  too  much  with  an  inflamed 
wound  a  more  and  more  serious  state  is  produced.  An 
aggressive  attack  upon  an  inflamed  trauma  is  always 
harmful.  When  such  a  wound  has  been  evacuated  of  its 
purulent  collection  and  the  accessible  dead  elements  have 
been  removed,  the  advancing  process  must  be  left  largely 
to  the  reactive  forces  of  the  body.  Antiseptic  packs 
covering  the  wound  and  the  swollen  environs  is  a  stand- 
ard treatment.     In  humans  it  is  never  omitted,  and  the 


TREATMENT  OF  WOUNDS  115 

antiseptic,  that  is  now  receiving  the  most  favor,  is  a 
saturated  solution  of  aluminum  acetate.     Boric  acid  so- 
lutions and  lead  acetate  solutions  are  also  highly  recom- 
mended.     There   is   little    doubt   that   such   packs    are 
helpful  in  animals  as  well  as  in  human  beings,  but 
with   us   they   are   seldom   renewed   often   enough  to 
be  of  real  service;  when  a  wound  is  discharging  copi- 
ously, they  tend  more  to  do  harm  than  good,  unless 
the  packing  material  is  changed  as  often  as  it  becomes 
soaked  with  pus.     Furthermore,  the  wrapping  must  not 
be  so  tight  as  to  dam  up  the  discharge.     To  apply  an 
antiseptic  pack  upon  a  badly  discharging  foot,  for  ex- 
ample, and  leave  it  to  become  soaked  with  serosity  during 
the  succeeding  twenty-four  hours,  is  not  good  treatment. 
On  the  other  hand,  if  the  entire  covering  were  changed 
three  or  four  times  a  da}^   a  certain  amount  of  good 
w^ould  accrue  from  such  treatment.    Hot  antiseptic  baths 
— a  popular  sort  of  treatment  in  the  veterinary  profes- 
sion— are  seldom  continued  long  enough,  or  done  clean 
enough,  to  be  of  much  service.     In  short,  I  doubt  very 
much  whether  any  form  of  local  antiseptic  treatment 
with  solutions  as  they  are  usually  used  on  animal  pa- 
tients ever  turns  the  course  of  any  local  infection.    The 
process   goes   on   in   spite   of   such  treatment,   and   the 
patient  sinks  or  swims  on  its  own  inherent  vitality.    It  is 
therefore  evident  that  the  best  recourse  we  have  is  the 
surgical  measures  above  recommended.     For  example, 
we    could   bathe    the    scrotum    in    cases    of    castration- 
funiculitis  hour  after  hpur,  and  day  after  day,  without 
any  good  effect,  but  the  moment  the  incision  is  opened 
and  the  collection  of  pus  drained  out,  the  patient's  tem- 
perature falls,  and  it  is  soon  on  the  high  road  to  recov- 
ery.    This  is  the  case  with  practically  every  venomous 
wound  with  which  we  have  to  deal ;  analogous  cases  may 
be  cited  ad  infinitum. 


116  WOUND  TREATMENT 

In  discussing  the  management  of  venomous  wounds, 
along  this  vein  of  non-interference,  I  was  once  chided  by 
a  student  for  performing  the  radical  operation  for  infec- 
tion of  the  navicular  sheath  from  a  nail  prick,  on  the 
ground  that  my  arguments  and  practices  were  discrep- 
ant. When  the  objects  of  this  operation  are  analyzed, 
however,  it  is  made  plain  that  the  whole  procedure  is 
nothing  more  than  the  drainage  of  a  pent-up  sero- 
purulent  collection  in  the  sheath  cavity.  The  apparent 
radical  part  of  the  operation  is  the  invading  dissection 
required  to  reach  the  hot-bed  of  the  infectious  wound. 

Wiping  out  venomous  wounds  frequently  with  clean 
wads  of  cotton,  keeping  the  surroundings  free  from  desic- 
cated discharges  and  dusting  freely  and  often  with  an 
antiseptic  (non-astringent)  powder  I  have  found  to  be 
the  best,  and  the  most  practical  treatment. 

The  resort  to  bacterins  should  not  be  ignored ;  the  best 
surgeons  are  using  them.  In  one  of  the  largest  surgical 
clinics  in  Chicago  a  bacterin  is  made  in  every  pus  case, 
and  as  this  practice  is  now  of  some  years'  standing,  it  is 
very  evident  that  benefit  is  derived  from  the  bacterins, 
for  otherwise  the  practice  would  long  since  have  been 
discontinued. 

Whenever  suppuration  continues  beyond  the  active  in- 
flammatory stage,  after  all  local  and  systemic  phenomena 
attending  the  process  have  ceased  to  exist,  then  the 
wound  treatment  must  be  directed  toward  the  underlying 
cause.  Foreign  bodies,  sloughs,  sequestra,  exposed  liga- 
ments, tendons,  cartilage  and  tooth  roots,  channels  be- 
tween layers  of  muscles,  or  outer  integument  extending 
in  a  downward  direction,  are  a  few  of  the  many  things 
capable  of  perpetuating  a  suppurative  process.  It  is  the 
surgeon's  duty  to  "hunt  these  out"  and  to  correct  mat- 
ters whenever  any  of  these  elements  are  found  to  exist. 

Treating  suppurating  tracts  day  after  day  and  week 


TREATMENT  OP  WOUNDS  117 

after  week  with  antiseptic  infections  is  useless,  until  the 
cause  of  the  suppuration  is  removed.  This,  of  course, 
is  elemental  and  well  known,  but  is  well  worth  repeat- 
ing. Sometimes  it  is  not  advisable  to  operate  too  early 
after  the  acute  inflammation  has  receded  because  the 
process  of  sequestration  may  not  have  progressed  far 
enough  to  enable  one  to  cut  out  all  that  will  eventually 
amputate  itself  from  the  living  tissues.  Thus  a  suppura- 
tion supervening  a  calked  coronet  points  to  quittor,  but 
if  we  operate  at  once  there  is  found  no  guide  to  the 
area  of  necrosis  in  the  cartilage.  After  a  little  procras- 
tination the  necrotic  area  will  become  distinguishable 
from  the  healthy  surrounding  and  can  be  removed  suc- 
cessfully. The  same  may  be  said  of  suppurating 
processes  due  to  exfoliation  of  bone  particles.  If  a  hasty 
reaction  is  made,  separation  is  not  complete,  and  a  second 
operation  will  be  required. 

Approaching  the  final  stage  of  healing,  venomous 
wounds  do  not  behave  as  well  as  aseptic  wounds.  The 
granulations  of  an  aseptic  wound  grow  safely  and  evenly 
to  maturity  like  a  healthy  tree,  while  those  of  infected 
wounds  are  erratic  in  their  behavior.  Some  may  become 
indolent  and  others  exuberant.  Indolent  granulations 
(ulceration)  are  rare  in  animal  wounds  except  from  im- 
proper treatment — treatment  that  stunts  them.  The 
continued  use  of  strong  antiseptics  or  the  too  early  resort 
to  astringents  (alum  powders,  for  example)  are  very 
harmful  to  wounds.  They  prevent  the  cells  from  grow^ 
ing  toward  a  healthy  maturity  and  delay  healing. 
Astringents  are  not  indicated  until  the  granulations  are 
level  with  the  surface  of  the  body ;  then  they  are  needed 
to  prevent  the  formation  of  a  protruding  scar.  Com- 
mon white  lotion  or  white  lotion  with  the  addition  of  a 
small  amount  of  copper  sulphate  is  hard  to  improve  upon 
as   an   astringent   for   the  last  stages  of  sclerogenesis. 


118  WOUND  TREATMENT 

Methylene  blue,  tannic  acid,  or  alum  are  also  effectual, 
but  these  are  not  indicated  in  cavities.  They  do  no 
good  in  such  locations  and  often  do  much  harm. 

The  growing  custom  of  using  alum  mixtures  indiscrim- 
inately as  a  stock  healing  powder  is  not  good  practice,  as 
such  strong  astringents  applied  to  wound  cavities  pre- 
vent instead  of  encourage  the  formation  of  new  tissue. 
Alum  or  any  other  astringent  application  is  indicated 
only  as  above  mentioned,  to  prevent  overgrowth  of 
granulations. 

Another  element  of  no  small  importance  in  the  treat- 
ment of  venomous  wounds  is  absolute  rest  of  the  inflamed 
part.  Movements  of  inflamed  wounds  is  disastrous,  while 
quietness  is  very  helpful.  Keeping  animals  tied  up 
instead  of  giving  them  the  freedom  of  a  paddock,  tying 
them  up  instead  of  exposing  wounds  to  the  movements 
of  getting  up  and  lying  down,  applying  immobilizing 
bandages  or  leg  braces,  are  just  so  many  means  of  pre- 
venting harmful  movements  of  infected  regions.  When 
a  human  surgeon  puts  a  patient  with  an  infected  foot 
to  bed,  or  places  an  infected  hand  or  arm  in  a  sling,  he  is 
doing  a  service  that  he  knows  is  more  beneficial  than  all 
the  other  treatment  he  is  able  to  devise.  The  same  must 
not  be  forgotten  in  the  treatment  of  brutes  that  never 
show  any  inclination  whatever  to  protect  their  wounds 
against  movements  or  even  serious  violence. 

Internal  treatment  for  venomous  wounds  is  usually  di- 
rected at  the  fever,  the  pain,  the  emunctories,  or  the 
infection  itself.  This  calls  for  antipyretics,  analgesics, 
diuretics,  purgatives,  and  internal  antiseptics.  When  a 
venomous  wound  threatens  to  be  mortal,  a  simple  line  of 
such  internal  medical  aid  should  be  carefully  planned. 
In  the  early  stage  when  the  pulse  rate  is  high  and  the 
character  full  and  bounding,  a  few  doses  of  aconite  has  a 
helpful  quieting  effect  on  the  circulation;  later  quinin 


TREATMENT  OF  WOUNDS  119 

in  small  repeated  doses  seems  best.  I  have  never  actually 
discerned  any  benefit  from  eccliinacea  or  any  other  in- 
ternal antiseptic.  Potassium  iodid,  in  an  article  entitled 
''The  Systemic  Handling  of  Wounds,"  by  Prof.  W.  L. 
Williams,  is  highly  lauded  as  helpful  in  controlling  the 
ravages  of  infections.  Analgesics  are  seldom  called  for 
in  animals.  Given  in  sufficient  dosage  to  allow  suffering 
patients  a  few  hours  of  rest,  they  are  always  apt  to  pro- 
duce delirium  or  a  blunted  state  that  is  prone  to  do  more 
harm  than  good  by  causing  the  animals  to  inflict  physical 
injury  to  the  infected  region.  Purgatives  must  be  ad- 
ministered cautiously,  as  an  uncontrollable  diarrhea  may 
ensue  upon  the  administration  of  a  purge  or  even  an 
oleaginous  cathartic  in  herbivora.  In  carnivora  a  good 
saline  is  always  indicated,  and  in  these  animals  it  may 
be  preceded  with  a  cholagogue  of  calomel  with  good 
results.  Among  the  diuretics  best  suited  for  this  purpose 
is  acetate  of  potassium  given  once  a  day  during  the 
period  of  active  inflammation.  As  for  internal  antisep- 
tics for  wound  sepsis,  "there  ain't  no  such  animal"  so 
far  as  the  writer  is  aware.  A  drug  that  would  actually 
destroy  focal  bacteria,  inhibit  their  activity,  or  in  some 
way  dispose  of  their  metabolic  products,  would  be  a 
blessing  par  excellence,  but  unfortunately  agents  capa- 
ble of  performing  this  feat  are  yet  undiscovered. 

Punctured  Wounds 

A  punctured  wound  is  always  more  dangerous,  or 
rather  more  treacherous,  than  one  with  a  wide  open 
cavity,  because  anaerobic  infection  is  more  grave,  or  at 
least  more  uncertain  in  its  terminations,  than  facultative 
or  aerobic  infections.  The  punctured  wound  is  also  grave 
because  of  the  inaccessibility  of  its  remotest  point  to 
direct  treatment.  If  the  bottom  of  a  punctured  wound 
could  be  reached  for  an  effectual  trimming  that  would 


120  WOUND  TREATMENT 

bring  out  every  vestige  of  the  soiled  tissue,  it  would  be 
no  more  dangerous  than  other  wounds,  and  when  the 
invading  incision  required  to  accomplish  this  mechanical 
disinfection  seems  feasible,  much  the  best  plan  of  punc- 
tured wound  treatment  is  to  get  right  down  to  the  bot- 
tom of  things  and  clean  out  the  whole  tract  at  once. 
When  this  is  not  feasible,  the  tract  should  be  opened 
as  far  as  possible  and  the  rest  cleaned  out  with  the  curette 
and  then  submitted  to  a  prolonged  irrigation  with  a 
weak  antiseptic  solution  or  else  cauterized  with  a  car- 
bolic swab.  Cauterization  should,  however,  never  be 
practiced  unless  it  is  positively  assured  that  the  very  bot- 
tom will  be  reached,  because  such  treatment  may  actually 
form  a  better  cloak  for  anaerobes  that  survive  beneath 
the  eschar.  A  splendid  example  of  punctured  wound 
cauterization  is  the  application  of  muriatic  acid  to  nail 
punctures  of  the  feet  of  horses.  If  the  tract  is  shallow, 
and  the  acid  reaches  its  depth,  the  wound  heals  promptly 
and  the  plan  (generally  carried  out  by  horseshoers)  is 
given  a  boost.  On  the  other  hand,  when  the  tract  is 
deep  and  therefore  only  partly  cauterized,  a  serious  sup- 
purative or  gangrenous  inflammation  is  sure  to  super- 
vene, and  if  the  patient  escapes  these,  tetanus  may  follow 
later. 

For  the  punctured  wounds  of  large  dimensions  pene- 
trating the  large  muscles  of  the  chest,  buttocks,  and 
neck  of  animals,  usually  sustained  by  collisions  v.  ith 
broken  stalls,  fences,  or  vehicles,  the  best  form  of  .steri- 
lization is  a  prolonged  irrigation.  The  tract  of  such  a 
wound  contains  torn  muscle,  shreds  of  fibrous  tissue, 
blood  clot,  and  hairs  and  dirt  carried  in  with  the  wound- 
ing object.  It  is  impossible  to  manage  these  because  of 
their  inaccessible  location  except  by  washing  out  every- 
thing that  is  loose  and  cleaning  everything  that  is  at- 
tached, by  a  diligent  irrigation.     An  attempt  should  be 


TREATMENT  OF  WOUNDS  121 

made  to  deposit  a  hose,  small  enough  to  allow  reflux, 
back  to  the  very  bottom  of  the  tract,  and  then  with  a 
fountain  syringe  or  hydrant  irrigate  the  tract  for  sev- 
eral hours.  Pure  water,  physiological  saline  solution,  or 
a  weak  antiseptic  should  be  used.  A  perfunctory  treat- 
ment of  this  kind  will  not  do  much  good,  but  a  prolonged, 
carefully  done  irrigation  may  perfectly  sterilize  such  a 
wound. 

The  following  case  serves  to  illustrate :  A  horse  sus- 
tained a  puncture  by  a  broken  shaft  of  a  single  wagon, 
extending  from  the  breast  to  the  level  of  the  olecranon. 
Having  determined  the  location  of  the  bottom  with  a 
long  sound,  a  counter-opening  was  made  through  the 
skin  behind  the  elbow.  A  hydrant  hose  was  placed  in 
the  counter-opening  and  a  good  stream  was  turned  on 
for  four  hours.  Besides  peppering  the  two  wounds  with 
an  antiseptic  powder  several  times  a  day,  no  other  treat- 
ment was  given  after  this  one  irrigation.  In  spite  of  the 
great  dimensions  of  this  wound  there  was  never  any  sup- 
puration and  the  patient  returned  to  work  in  exactly 
three  weeks,  entirely  healed  up.  The  success  here  was 
due  to  the  perfect  sterilization  by  the  long  irrigation. 
Whenever  such  irrigations  are  attempted,  provisions  must 
always  be  made  for  a  free  reflux  of  the  water  by  using 
a  hose  of  smaller  caliber  than  the  tract,  otherwise  in- 
fected material  might  be  driven  into  the  tissue  spaces  far 
beyond  the  original  wound. 

For  smaller  punctured  wounds  that  can  not  easily  be 
mechanically  disinfected,  a  loose  antiseptic  wick  should 
be  inserted  along  the  whole  tract  and  changed  fre- 
quently. This  may  be  preceded  by  injections  of  hydro- 
gen peroxide. 

Finally,  a  dose  of  antitetanic  serum  is  given  in  all 
punctured  wounds  to  prevent  tetanus.  The  dose  should 
vary  from  500  to  1,500  units,  according  to  time  of  ad- 


122  WOUND  TREATMENT 

ministration.  On  the  first  or  second  day  500  units  will 
answer,  but  when  the  wound  is  older,  1,000  units  to 
1,500  units  will  be  required  to  assure  immunity. 

Gunshot  Wounds 

We  shall  not  attempt  to  describe  a  treatment  for  all  of 
the  various  wounds  capable  of  being  inflicted  by  fire- 
arms. Their  varieties  forbid  in  a  short  review  of  wound 
treatment,  and  the  writer,  like  probably  all  American 
veterinarians  except  a  few  in  our  army  who  saw  service 
in  the  Philippines,  must  plead  inexperience.  As  the 
fund  of  information  in  this  connection  is  about  to  be 
enlarged  by  the  untold  range  of  experience  and  observa- 
tion of  our  European  confreres,  it  would  be  presump- 
tuous for  one  in  my  position  to  venture  into  this  domain 
at  this  particular  moment. 

In  peace  times  veterinarians  only  rarely  encounter 
wounds  made  by  firearms,  and  when  they  are  met  they 
are  generally  from  low-power  guns  or  shotguns:  These, 
of  course,  inflict  wounds  of  a  different  character  than 
those  of  high-pressure  rifles  used  by  modern  armies,  say- 
ing nothing  of  shrapnel,  shells,  bombs,  grenades,  etc.,  in- 
cluded in  their  ordnance.  It  is  the  wounds  of  these 
modern  arms  that  interest  us  most  to-day,  and  as  peace 
may  not  always  be  our  good  fortune,  it  stands  us  in  hand 
to  acquaint  ourselves  with  the  present  experiences  of  the 
able  veterinarians  of  the  European  armies  now  in  the 
field. 

At  present  I  shall  content  myself  with  a  few  simple  rec- 
ommendations. The  old  custom  of  immediately  search- 
ing for  a  bullet  imbedded  in  the  body  has  long  since 
been  abandoned.  It  is  only  the  plainly  felt  subcutaneous 
bullet  that  is  removed  to-day.  Those  lodged  deeper,  even 
though  they  may  have  been  located  by  the  Rontgen 
rays,  are  left  strictly  alone  to  become  encysted  or  to  form 


TREATMENT  OF  WOUNDS  123 

an  abscess.  In  the  latter  event,  the  bnllet  is  removed 
when  the  pus  of  the  well  matured  abscess  is  evacuated. 
"Do  not  search  for  bullets  unless  they  can  be  clearly  felt 
through  the  skin,  but  leave  them  to  the  tissues  where  they 
will  either  be  tolerated  or  expelled  by  suppuration." 
(Cadeac.)  Thus  Cadeac  in  a  word  says  about  all  there 
is  to  be  especially  said  about  extraction  of  bullets.  The 
tract  of  the  bullet  is  not  irrigated,  nor  is  there  any  effort 
made  to  explore  its  depths.  Local  antiseptic  treatment 
of  the  orifice  to  avert  secondary  infection  is,  however, 
faithfully  followed  and  the  patient  is  watched  continu- 
ously for  febrile  complication  and  for  the  abscess  that 
will  disclose  the  location  of  the  bullet.  Antitetanic  serum 
is  always  indicated,  and  should  never  be  omitted,  in  the 
management  of  firearm  wounds. 


WOUND  HEALING 

By  A.  T.  KINSLEY,   M.Sc,   D.V.S. 

The  subject  of  wound  healing  is  not  new.  It  has  been 
discussed  by  eminent  pathologists  and  surgeons  for  hun- 
dreds of  years.  This,  like  some  other  problems  in  patho- 
logic surgery,  appears  to  especially  attract  the  attention 
of  the  general  medical  profession  periodically  and  spas- 
modically. Thus  Lister's  principles  of  antiseptic  dress- 
ings and  aseptic  surgery  caused  marked  modifications  of 
methods  in  wound  treatment  and  resulted  in  a  great  ad- 
vancement of  surgery.  Yet  Listerian  principles  are  not 
so  universally  employed  by  veterinarians  as  they  should 
be.  The  reason  for  the  existence  of  this  state  of  affairs 
is  difficult  of  explanation. 

Bacterins  an  Aid  in  Wound  Treatment 

Recently,  following  the  lead  of  medical  investigators, 
another  advancement  has  been  made  in  the  knowledge  of 
wound  healing.  This  newer  method  consists  of  increas- 
ing the  animal's  resistance  to  infection  by  the  stimula- 
tion of  its  tissues  to  form  specific  opsonins.  Opsonic 
therapy  is  and  has  been  increasing  the  possibilities  of 
surgery  and  rendering  all  major  operations  less 
hazardous. 

Wounds  and  Their  Classification 

A  wound  may  be  defined  as  an  interruption  of  the 
continuity  of  tissue  or  tissues.  Some  have  restricted  the 
term  to  those  conditions  resulting  from  traumatism. 
Others  have  confined  it  to  injuries  of  soft  tissues,  while 

125 


126  WOUND  TREATMENT 

still  others  maintain  that  wounds  occur  only  upon  the 
surface.  There  are  no  good  reasons  for  these  restric- 
tions, because  thermic  and  chemic  influences  produce 
interruption  of  tissues  which  are  not  unlike  and  are  not 
distinguished  from  wounds  mechanically  inflicted ;  again, 
a  fracture  is  a  break  in  the  continuity  of  osseous  tissue 
and  is  repaired  in  exactly  the  same  way  as  is  a  wound 
in  soft  tissue;  and  further,  a  rupture,  as  of  the  liver  or 
spleen,  is  characterized  by  tissue  destruction  and  inter- 
ruption of  the  continuity  of  the  integral  parts  of  the 
injured  organ,  all  of  which  are  conditions  not  easily  dif- 
ferentiated pathologically  from  wounds.  Usually  the 
term  ''wound"  is  restricted  to  those  injuries  that  are 
produced  by  sudden  violent  action;  thus  ulcers  and  ne- 
crotic tubercular  centers  are  not  wounds.  A  bruise  may 
or  may  not  be  a  wound,  depending  upon  the  nature  of 
the  lesion ;  that  is,  whether  or  not  an  interruption  of  the 
tissue  has  been  effected. 

There  are  a  variety  of  ways  of  classifying  wounds,  of 
which  the  following  will  serve  for  discussion:  Etiolog- 
ically,  wounds  may  be  traumatic,  chemic,  or  thermic; 
topographically,  wounds  may  be  surface  or  subsurface, 
and  again  they  may  be  facial,  cervical,  thoracic,  abdom- 
inal, and  so  on.  According  to  character,  wounds  may 
be  incised,  punctured,  lacerated,  contused,  as  produced 
by  a  stab,  shot,  or  bullet,  or  a  bite.  As  to  condition, 
wounds  may  be  infected  or  non-infected. 

How  Wound  Healing  Is  Accomplished 

Wound  healing  is  the  simultaneous  regeneration  of  the 
tissue  of  an  area  in  which  there  has  been  previous  destruc- 
tion. Traumatic  wounds  usually  heal  more  readily  than 
wounds  resulting  from  thermic  or  chemic  causes,  be- 
cause traumatisms  are  the  result  of  mechanical  force 


WOUND  HEALING  127 

only,  and  the  destructive  influence  ceases  immediately 
upon  removal  of  the  cause,  whereas  the  influence  of 
thermic,  and  especially  chemic,  causes  continues  for  a 
variable  period. 

Many  methods  of  wound  healing  have  been  described, 
such  as  immediate  union,  primary  union,  secondary 
union,  tertiary  union  or  intention,  healing  under  a  scab, 
and  so  on.  When  the  exact  conditions  are  understood, 
it  is  found  that  practically  all  wound  healing  is  of  one 
or  the  other  of  two  types,  primary  union  or  first  inten- 
tion, and  healing  by  secondary  union  or  granulation. 

The  process  of  healing  by  primary  union  embraces 
coagulation  of  the  hemorrhagic  extravasate,  agglutination 
of  the  wound  margins,  hyperemia,  inflammation,  vas- 
cularization, fibrous  formation,  disintegration  of  the 
hemorrhagic  extravasate  and  inflammatory  exudate, 
cicatrization,  epithelization,  and  substitution,  the  time 
required  for  the  latter  being,  much  greater  than  the 
former. 

The  other  type  of  healing — that  is,  by  granulation — 
is  the  type  usually  observed  in  the  majority  of  wounds 
in  the  domestic  animals.  It  is  this  type  in  which  there 
is  a  continued  infection  and  a  continual  destruction  of 
the  newly  generated  tissue,  thus  necessarily  increasing 
the  length  of  time  required  for  the  wound  gap  to  be 
filled  with  new  tissue.  This  type  of  wound  healing  can 
be  obtained  by  any  one  and  under  any  conditions  sur- 
rounding it.  It  is  certainly  no  credit  to  a  veterinarian 
to  have  under  his  care  several  cases  of  wound  healing  in 
which  the  method  of  healing  is  by  granulation. 

Prevailing  Methods  Deplorable 

Healing  by  primary  union  is  desirable  in  all  wounds. 
Unfortunately,  this  method  of  wound  healing  is  not  ob- 
tained as  frequently  as  it  should  be  in  veterinary  practice. 


128  WOUND  TREATMENT 

The  majority  of  practitioners  have  thus  far  not 
attempted  to  obtain  primary  wound  healing  in  any 
except  small  surgical  Avounds.  Often  surgeons  do  not 
properly  prepare  their  fields  of  operation  and  do  not 
give  the  proper  care  and  after-treatment  of  surgical 
wounds  to  favor  this  type  of  healing.  This  is  deplor- 
able, and  is  one  of  the  most  frequent  causes  of  condemna- 
tion of  veterinarians.  Why  veterinarians  take  no  more 
pains  than  they  do  to  observe  antiseptic  precautions 
in  their  surgical  operations  is  difficult  to  explain.  Most 
practitioners  make  the  plea  that  they  have  not  the  time 
to  do  aseptic  surgery,  and  that  their  clientele  will  not 
pay  for  this  kind  of  operation.  Such  surgeons  are 
really  to  be  pitied,  for  it  is  indicative  of  improper  under- 
standing of  aseptic  surgery,  as  well  as  showing  that  they 
have  failed  to  impress  their  clientele  by  their  surgical 
efficiency. 

Advantages  of   Good   Surgery 

If  a  surgeon  will  successfully  perform  two  or  three 
aseptic  surgical  operations,  in  which  the  wounds  heal 
by  primary  union,  he  will  have  no  difficulty  in  obtain- 
ing future  cases  and  a  good  fee  for  aseptic  surgical 
operations  in  the  same  community.  It  is  not  an  impos- 
sibility and,  further,  it  is  not  difficult  to  obtain  primary 
wound  healing  even  in  large  lacerated  wounds.  Cer- 
tainly, time  is  required  to  prepare  the  wound,  but  after 
the  first  dressing  little,  if  any,  attention  is  required, 
and  the  advantages  obtained  more  than  offset  the  extra 
time  required  in  placing  the  wound  in  such  a  condition 
that  it  will  heal  by  primary  union.  This  type  of  healing 
is  rapid,  and  seldom  leaves  an  unsightly  scar;  thus  the 
animal  is  back  in  service  in  a  very  short  time.  The 
value  of  the  animal  is  not  then  depreciated  by  unsightly 
scars,  and  the  actual  time  required  of  the  surgeon  is 


WOUND  HEALING  129 

less  than  it  would  have  been  had  he  permitted  the  wound 
to  remain  infected  and  thus  require  daily  treatments. 

Aseptic  Surgery  and  Wound  Dressing 

Large  lacerated  wounds  are  properly  prepared  by  first 
shaving  the  hair  from  all  adjacent  tissues,  then  thor- 
oughly cleansing  the  wound  and  marginal  tissues  and 
removing  all  fragments  of  tissue,  after  which  the  wound 
margins  are  brought  in  apposition  and  maintained  in  a 
fixed  immobile  position.  The  method  of  procedure  that 
should  be  resorted  to  in  cleansing  a  wound  prior  to 
bringing  the  various  parts  of  it  in  apposition  with  sutures 
or  otherwise,  should  be  determined  by  the  nature  of  the 
wound.  In  a  lacerated  wound  in  which  there  has  been 
introduced  filth,  such  as  dirt,  fecal  matter,  and  hair,  the 
parts  should  be  thoroughly  washed  with  physiologic  salt 
solution  until  the  filth  has  been  entirely  removed.  The 
tissue  shreds  should  then  be  removed  by  the  use  of 
sterile  instruments,  and  some  disinfectant  used  in  further 
cleansing  the  part.  The  application  of  the  disinfectant 
should  be  again  followed  by  washing  with  sterile  physio- 
logic salt  solution,  for  be  it  remembered  that  if  disin- 
fectants are  applied  tissues  are  destroyed,  the  extent 
of  which  will  depend  upon  the  strength  of  the  disin- 
fectant and  the  duration  of  its  application ;  the  purpose 
of  the  application  of  the  disinfectant  is  to  insure  the 
destruction  of  all  infectious  agents,  and  the  object  of 
the  application  of  the  salt  solution  after  the  disinfectant 
is  to  wash  away  all  excess  disinfectant. 

Such  treatment  of  a  wound  will  necessarily  require 
considerable  time.  I  have  seen  some  such  wound  treat- 
ment, and  in  one  instance  I  remember  where  the  irriga- 
tion with  the  salt  solution  was  continued  for  four  to  five 
successive  hours.    In  this  wound  some  thirty  sutures  were 


130  WOUND  TREATMENT 

taken,  the  wound  healed  by  primary  union,  and  the 
animal  was  back  in  service  within  a  week. 

If  a  lacerated  wound  is  fresh  and  clean,  thorough 
irrigation  for  from  thirty  minutes  to  two  hours  with  a 
salt  solution  is  preferred  without  the  application  of  a 
disinfectant. 

After  the  wound  is  thoroughly  cleansed,  the  various 
parts  of  it  may  be  adjusted,  the  kind  of  suture  and  the 
method  of  suturing  depending  upon  the  nature  of  the 
wound,  always  selecting  that  type  of  suture  which  will 
hold  it  in  the  best  position  with  the  least  destruction  of 
tissue.  When  a  wound  is  sutured,  especially  if  it  is  of 
large  size,  it  is  necessary  to  provide  it  with  drainage. 

In  the  treatment  of  granulation  wounds  of  long  stand- 
ing, it  is  possible  in  many  instances  to  render  them 
aseptic  and  bring  the  wound  margins  in  apposition,  thus 
inducing  primary  union.  In  some  instances,  however, 
there  is  so  much  tissue  destroyed  that  it  is  impossible 
to  obtain  immediate  union,  even  though  the  wound  is 
thoroughly  cleansed. 

Antiseptics  Often  Misused 

There  is  no  question  but  that  the  application  of  anti- 
septics as  frequently  practiced  is  harmful,  and  that  the 
tissues  are  often  injured  and  wound  healing  retarded 
by  the  application  of  such  agents.  Wounds  are  pro- 
tected by  the  inflammatory  exudate  which  usually  oozes 
to  the  surface,  thus  favoring  granulation,  which  ulti- 
mately results  in  the  filling  of  the  gap  and  completing 
the  union  of  the  tissues,  the  time  required  being  much 
less  than  if  tissues  are  repeatedly  destroyed  by  the 
frequent  application  of  antiseptics. 


REPAIR  OF  WOUNDS ' 

By  WILLIAM  BRADY,  M.D.,  Elmira,  New  York 

The  general  management  of  wonnds  should  be  based 
on  a  practical  knowledge  of  the  physiology  and  path- 
ology of  repair.  With  a  thorough  understanding  of  the 
process  of  healing  the  young  tyro  may  bring  about  the 
cure  of  old  varicose  or  other  ulcers  which  his  senior  col- 
leagues have  perhaps  pronounced  incurable  after  years 
of  empirical  tinkering  with  various  highly  recommended 
ointments.  Without  going  into  details,  a  brief  considera- 
tion of  certain  features  of  the  healing  process  may  be 
of  interest. 

In  a  wound  not  aseptic,  inflammatory  symptoms  are 
apt  to  appear  on  the  second  day.  Every  case  should 
therefore  be  seen  at  this  time,  whether  the  dressing  is  to 
be  disturbed  or  not.  It  is  often  wise  to  leave  a  strand 
of  silkworm  or  gauze  in  the  lower  angle  of  an  acci- 
dental wound  of  whose  asepsis  there  is  much  doubt, 
and  to  remove  it  on  the  second  or  third  day  if  the 
wound  is  clean.  The  best  dressing  for  such  a  case  is  the 
wet  normal  salt  gauze,  which  is  undeniably  superior  to 
dry  gauze  or  ointments  as  a  medium  for  drainage  for 
exuding  serum. 

Sutures,  if  inserted,  should  be  removed  on  the  fifth  day 
if  there  is  no  tension  upon  the  edges  of  the  wound.  If 
tension  is  unavoidable,  the  sutures  should  remain  until 
about  the  tenth  day.  It  is  generally  well  to  reinforce, 
or  even  replace,  suturing  by  adhesive  strapping  to  relieve 
undue  tension.    A  wounded  extremity  is  always  more  at 


iReprint  from  Medical  Summarij. 

131 


132  WOUND  TREATMENT 

rest  in  a  flexed  position,  if  such  position  does  not  cause 
gaping"  of  the  wound.  Absolute  rest  is  best  attained  by 
means  of  suitable  splints,  or  firm  bandages  in  wounds 
of  sufficient  importance  to  require  it  or  make  it  advisable. 

The  floor  of  a  deep  laceration,  as  of  the  perineum, 
becomes  covered  after  several  hours  with  a  varnish-like 
glazing  of  coagulated  fibrin  from  the  exuded  serum. 
Suturing  at  this  stage  will  ofttimes  give  first-intention 
union  even  better  than  primary  suturing. 

If  not  closed,  an  open  glazed  wound  becomes  covered 
in  two  or  three  days  with  a  dirty  grayish  membrane, 
which  separates  after  a  few  days  and  is  discharged  with 
the  pus,  leaving  a  base  of  bright  red  granulation  tissue. 
Granulation  tissue  is  the  vascular  framework  upon  which 
cicatricial  tissue  grows.  When  it  reaches  the  level  of  the 
skin,  a  transparent,  delicate  film  appears  around  the 
edges  and  extends  gradually  out  toward  the  center  of 
the  granulating  surface,  like  ice  freezing  over  a  pond. 
This  film  is,  of  course,  new  epithelium,  though  I  have 
seen  nurses  and  doctors  carefully  wiping  it  away  with 
wet  gauze  or  cotton  in  the  blissful  notion  that  it  was 
foreign  material. 

New  epithelial  cells  are  as  readily  destroyed  by  chem- 
ical antiseptics  as  are  pyogenic  bacteria.  There  is  not 
only  no  excuse  for  washing  a  healing  wound  with  germi- 
cides, but  positively  a  contraindication  to  such  maltreat- 
ment.    Asepsis,  not  antisepsis,  is  the  goal  to  strive  for. 

Granulation  tissue  in  large  wounds  or  ulcers  aids  re- 
pair also  by  contracting  and  drawing  the  edges  closer 
together.  This  gives  us  a  valuable  hint  for  the  use  of 
adhesive  plaster  about  larger  granulating  surfaces.  As 
to  strapping  directly  upon  the  granulations,  personally 
I  have  had  only  unpleasant  results. 

A  wound  whose  edges  are  not  approximated  may  still 
heal  without  suppuration  if  it  be  filled  with  aseptic  blood 


REPAIR  OF  WOUNDS  133 

clot,  and  kept  aseptic — that  is,  left  alone.  A  clean  clot 
is  an  excellent  culture  medium  for  embryonic  epithelial 
cells.  As  healing  progresses,  a  portion  of  the  unab- 
sorbed  clot  is  pushed  out  by  the  granulating  tissue  and 
dries  in  a  scab  which  protects  the  surface  of  the  wound. 
Aseptic  clot  repair  occurs  typically  in  simple  fractures, 
subcutaneous  tenotomes,  internal  rupture  of  organs,  and 
healing  of  bone  cavities  following  the  radical  operation 
on  sequestra.  It  is  nature's  peerless  method,  and  one 
that  we  should  endeavor  to  imitate  whenever  the  con- 
ditions permit.  No  other  packing  is  as  good  as  clean 
blood  clot.     No  other  wash  is  as  good  as  blood  serum. 

Given  a  recent  wound  of  accidental  nature,  how  shall 
we  render  it  aseptic?  In  ordinary  cases  one  thorough 
cauterization  with  iodin  is  usually  sufficient,  all  subse- 
quent dressings  to  be  without  antiseptics  of  any  kind. 
In  wounds  which  give  rise  to  the  fear  of  tetanus  or 
rabies,  however,  pure  phenol  is  preferable.  If  the  wound 
has  a  cavity,  the  phenol  should  be  poured  in  after  moist- 
ening the  surrounding  skin  with  alcohol,  and  allowed  to 
remain  one  minute.  It  may  then  be  removed  with  a 
dropper,  and  alcohol  applied.  If  it  is  a  puncture  wound, 
the  phenol  must  be  applied  on  a  cotton-wrapped  probe, 
opening  the  track  of  the  puncture  if  necessary  to  permit 
access  to  the  farthest  point.  If  it  be  a  freely-bleeding 
wound,  and  still  bleeding,  I  believe  cauterizing  is  un- 
necessary under  any  conditions. 

Many  authorities  are  now  reporting  happy  results  from 
leaving  granulating  wounds  and  ulcers  freely  exposed 
to  the  air,  under  a  wire  netting  for  protection  against 
insects  or  injury.  Some  writers  report  excellent  results 
from  treating  skin  grafts  in  this  manner. 

Brewer's  yeast  is  a  remedy  I  have  found  very  useful 
for  hastening  the  separation  of  old  sloughs  and  stimu- 
lating granulations.     It  smarts  a  trifle,  but  patients  do 


134  WOUND  TREATMENT 

not  object  to  it,  especially  when  they  find  they  can 
obtain  it  for  the  asking.  I  have  also  given  it  in  doses 
of  one  to  two  ounces  internally,  though  with  doubtful 
effects. 

For  painful  wounds  and  ulcers  generally  a  simple 
dressing  kept  wet  with  warm  normal  saline  solution 
seems  most  useful.  The  patient  appreciates  it  better  if 
he  is  given  normal  salt  tablets  (which,  by  the  way,  make 
real  imitation  plasma),  rather  than  being  directed  to 
dump  a  teaspoonful  of  common  salt  into  a  dish  of 
w^ater. 

For  ugly,  painful  old  varicose  ulcers  a  boon  to  the  new 
doctor  on  the  case  is  orthoform,  applied  either  as  a  dust- 
ing powder  or  in  five-per-cent  ointment.  Some  patients 
will  develop  erythema  from  orthoform,  much  like  those 
formerly  common  when  iodoform  was  in  use. 

For  exuberant  granulations — "proud  flesh,"  as  pa- 
tients seem  to  call  it — I  like  the  scissors.  It  can  usually 
be  trimmed  off  without  discomfort.  If  this  is  not  per- 
missible, then  firm  pressure  is  the  next  method  of  choice. 
My  experience  with  silver  nitrate  has  been  uniformly 
unsatisfactory.  So  far  as  I  can  see,  silver  nitrate  merely 
musses  up  the  field  of  operations  and  stimulates  the  gran- 
ulations to  renewed  activity.  The  clean,  prompt,  effect- 
ual way  to  remove  proud  flesh  is  to  cut  it  down. 

Carbolic  acid,  in  any  other  role  than  as  a  cauterant, 
is  to  be  mentioned  only  to  be  condemned.  There  is 
nothing  known  to  domestic  surgery  that  will  delay  heal- 
ing of  a  simple  wound  like  carbolic  salve,  unless  it  be  a 
fresh  and  reeking  poultice  of  genuine  cow  dung. 

Antiseptics,  other  than  cauterants  or  recognized  disin- 
fectants, might  well  be  discarded  from  the  office  al- 
together. We  have  little  use  for  them.  Once  having 
asepticized  a  wound,  I  am  sure  the  best  policy  from  that 
point  on  is  to  avoid  antiseptics  and  depend  wholly  upon 


REPAIR  OF  WOUNDS  135 

simple  cleanliness,  with  due  regard  to  the  all-important 
consideration  of  the  patient's  opsonic  immunity  and  gen- 
eral condition. 

Vaccine  therapy  and  internal  medication  are  chapters 
by  themselves.  Our  chief  duty  is  to  stand  by  fully  armed 
while  nature  does  the  work. 

In  dry  old  varicose  ulcers,  carbuncles  with  little  fluid 
drainage,  and  indurated  swellings  of  various  kinds  in 
which  incision  is  not  productive  of  the  usual  benefit, 
the  engorgement  and  coagulation  of  lymph  in  the  ves- 
sels about  the  lesion  is  probably  preventing  free  access 
of  fresh  opsonins  or  antibodies  to  the  site  of  infection. 

Wright  and  others  report  good  results  in  such  cases 
from  the  use  of  citric  acid  internally  in  sixty-grain  doses 
every  three  hours  until  a  freer  exudation  of  serum  is 
obtained  from  the  wound.  The  local  use  of  citrate  of 
sodium  and  salt  solution  is  also  advised — one  tenth  of 
one-per-cent  citric  acid  and  four-per-cent  sodium  chlorid 
wet  dressings. 

One  case  of  Ludwig's  angina,  reported  by  Sir  Alm- 
roth  Wright,  seemed  hopeless  despite  free  vertical  inci- 
sions in  the  neck  and  a  measured  opsonic  index  of  1.8, 
there  being  serious  physical  prostration  and  insufficient 
exudation  from  the  incisions  to  enable  Wright  to  ''fill  a 
platinum  loop"  for  culture.  Yet  two  or  three  doses  of 
citric  acid,  as  mentioned  above,  resulted  in  free  oozing 
from  the  incisions  and  immediate  institution  of  convales- 
cence. As  Wright  says,  it  was  not  the  patient's  lack  of 
resisting  power,  not  his  need  of  vaccine  treatment  (as 
shown  by  the  opsonic  index),  but  merely  the  choking  of 
the  lymph  vessels  about  the  induration  which  prevented 
his  ample  supply  of  antibactericiclal  bodies  from  reach- 
ing the  Streptococci  in  the  wound  or  lesion,  and  bring- 
ing about  recovery. 


SURGERY  IN  WOUND  TREATMENT ' 

By  JOHN  ERNST,  D.V.M.,  Salt  Lake  City,  Utah 

Wiounds  are  generally  understood  as  being  a  solution 
of  continuity.  They  belong  to  the  division  of  medical 
science  known  as  surgery.  This  does  not  allude  to  oper- 
ative surgery  alone,  but  includes  such  medical  agents  as 
may  be  or  are  applied,  with  a  view  or  for  the  purpose  of 
accomplishing  certain  specific  results.  It  is  said  that 
"it  ought  to  be,  as  a  matter  of  course,  (perhaps  it  is  so 
in  point  of  fact)  that  no  one  of  intelligence  and  integrity 
will  assume  the  duties  and  responsibilities  of  surgical 
practice  without  the  due  preparation  and  equipment, 
which  is  only  to  be  acquired  by  conscientious  study  and 
complete  knowledge  of  medical  science  at  large." 

Especially  and  indispensably,  a  surgeon  must  be  an 
accomplished  anatomist.  His  knowledge  must  be  thor- 
ough in  the  several  divisions  of  anatomical  science.  He 
must  possess  a  familiar  acquaintance  with  descriptive 
anatomy;  he  must  be  fully  instructed  in  surgical  anat- 
omy or  the  anatomy  of  regions ;  he  must  have  mastered 
the  last  chapter  in  pathological  anatomy;  and  if  there 
•are  any  other  kinds  of  anatomy  he  must  master  them  all, 
and  then  he  will  have  become  an  anatomist  in  fact  and 
qualified  to  practice  surgery.  Yes;  a  surgeon  must  be 
an  anatomist,  and  it  ought  to  go  without  saying  that 
only  a  surgeon  should  practice  surgery,  whether  his  pa- 
tient be  biped  or  quadruped.  No  untrained  layman 
should  presume  to  wield  the  knife  and  the  cautery  with 
their   associated   arsenal   of   weapons   and   their   appli- 


'Read  at  meeting  of  the  Utah  Veterinary  Medical  Association. 

137 


138  WOUND  TREATMENT 

ances  for  the  subjugation  of  the  enemy  whose  assaults 
it  is  the  special  provision  of  the  surgeon  to  repel.  An 
ignorant  operator  may  easily  become,  himself,  a  more 
dangerous  ''lesion"  than  some  of  those  which  we  pre- 
sume to  treat.  The  man  who  can  cut  into  the  living  and 
usually  hypersensitive  flesh  of  suffering  animals,  with- 
out knowing  what  tissues  or  organs  he  is  attacking, 
what  arteries  he  is  likely  to  sever,  what  nerves  to  wound, 
what  organs  to  lacerate,  what  functions  to  paralyze — 
such  a  man,  if  he  be  found,  should  simply  be  subjected 
to  an  odium  which  should  ostracize  him  from  honorable 
and  equal  association  with  other  of  his  species,  besides 
being  held  criminally  amenable  to  the  law  providing 
penalties  for  the  perpetrators  of  cruelty  to  animals. 

These  reflections  may  be  unnecessary,  but  it  is  all  too 
true  that  our  domestic  animals  too  often  become  the 
victims  of  worse  than  brutal  masters,  who  take  advan- 
tage of  their  helplessness  and  inferiority  to  inflict  upon 
them  cruelties  so  gross  and  aggravated  that  right-feeling 
men  are  often  compelled  to  blush  to  call  them  fellows. 
It  is  no  excuse  for  this  that  it  is  done  through  the 
agency  of  a  pseudo-surgeon ;  such  a  plea  merely  doubles 
the  number  of  the  wrongdoers. 

With  the  skill  of  the  expert  anatomist  must  be  asso- 
ciated, of  course,  the  necessary  mastery  of  therapeutics, 
and  a  familiar  knowledge  of  special  and  general  path- 
ology, and  all  should  be  supplemented  by  a  knowledge 
of  the  theory  and  practice  of  the  farrier. 

The  science  and  the  application  of  the  laws  of  hygiene, 
so  generally,  indeed  almost  wholly,  ignored  by  our  fa- 
thers, and  so  largely  a  discovery  of  the  present  time, 
should  never  be  overlooked  or  depreciated  by  the  gen- 
uine surgeon.  The  fullest  attention  to  the  theories  and 
applications  of  what  may  be  denominated  the  science  of 
antisepsis,  now  so  universally  and  unintermittently  an 


SURGERY  IN  WOUND  TREATMENT        139 

adjunct  to  all  medical  and  surgical  practice  and  so 
utterly  indispensable  in  the  departments  of  dressing  and 
nursing,  and  so  often  an  available  and  valuable  aid  in 
the  very  act  of  operating,  must  be  considered  to  have 
become  an  incorporated  and  constituent  department  of 
the  domain  of  surgery  and  medicine  as  well,  and  the 
cultured  veterinarian  will,  of  course,  so  regard  it  in  his 
practice. 

Besides  the  special  scientific  attainments  to  which  we 
have  referred,  there  are  many  other  qualifications  which 
must  enter  into  the  character  of  the  good  and  skillful 
surgeon,  in  order  to  round  it  into  true  symmetry  and 
proportion.  Bouley  remarks  that  ''he  must  not  only  be 
a  man  of  science,  but  a  man  of  art,"  meaning,  we  sup- 
pose, that  he  should  not  only  possess  knowledge  but  know 
how  to  make  it  available.  First,  he  must  possess  the 
faculty  of  knowing  how  to  gauge  the  necessity  of  his 
interference,  with  its  manner  and  its  duration ;  or,  on  the 
other  hand,  whether  any  interference  is  necessary,  and 
whether  the  true  indication  is  not  to  refrain  from  active 
measures.  The  result  of  his  decision  will  afford  a  good 
test  and  gauge  of  the  extent  to  which  he  has  profited  by 
his  clinical  and  theoretical  study.  He  is  a  wise  philoso- 
pher who  can  wisely  determine  when  to  let  alone  in  oppo- 
sition to  the  temptation  to  do  something.  Courage  and 
coolness,  with  patience,  are  essential  qualities  of  tem- 
per in  an  operating  surgeon.  To  become  alarmed  and  lose 
his  balance  on  the  occurrence  of  some  untoward  inci- 
dent, or  the  appearance  of  some  unlooked-for  abnormal 
development  or  complication,  or  to  give  way  to  a  spirit 
of  impatience  because  of  unexpected  delay,  or,  especially, 
to  resent  the  fractious  movements  of  the  suffering  ani- 
mals writhing  under  the  knife  or  the  glowing  cautery, 
is  both  unprofessional  and  unmanly.  The  terms,  cour- 
age, coolness,  patience,  and  kindness  should  describe 
his  state  of  mind  while  operating. 


140  WOUND  TREATMENT 

Every  movement  of  the  surgeon  should  be  prompt  and 
precise.  Indeed,  by  operating  rapidly  he  shortens  the 
duration,  and  consequently  the  sum,  of  the  pain,  and 
thus  diminishes  the  anguish  of  a  long  and  torturing 
infliction  on  behalf  of  the  patient.  The  maintenance  of 
his  own  self-possession  will  make  him  master  of  the 
situation,  and  assure  a  neat,  artistic  finish  to  his  task, 
with  no  unnecessary  division  of  tissues,  no  mistaking  of 
locations,  and  generally  with  no  betrayals  of  doubt  and 
hesitation  or  awkward  and  aimless  manipulations,  such 
as  mark  the  attempts  of  the  tyro  and  the  novice. 

The  confidence  and  facility  with  which  each  move  is 
accomplished  will  not  fail  to  impress  favorably  those 
who  are  spectators  of  the  operation,  and  to  react  fa- 
vorably and  profitably  for  the  operator.  The  operative 
function  of  veterinary  surgery  requires,  on  the  part  of 
the  man  who  practices  it,  a  certain  corporeal  vigor,  asso- 
ciated with  sufficient  agility  to  be  able  effectually  to  over- 
come the  resistance  of  animals  under  torture,  and  coun- 
teract the  efforts  and  ^void  the  injuries  they  are  always 
so  prompt  and  often  so  dexterous  in  inflicting  upon 
those  who  are  causing  them  pain.  The  veterinary  sur- 
geon must  be  cool-blooded  and  patient,  never  losing  his 
presence  of  mind  while  directing  the  manipulations, 
often  so  difficult  and  dangerous,  which  are  necessitated  at 
his  hands,  especially  when  the  large  domestic  animals  are 
under  treatment.  He  must  then — always,  in  fact — be 
prepared  for  all  difficulties  and  eventualities  that  may 
arise,  whether  before,  during,  or  after  an  operation,  and 
he  must  inspire  confidence  in  his  assistants  by  using  full 
precautions  for  their  safety  and  for  his  own,  in  his  de- 
fensive dispositions  against  the  dangers  to  which  they 
are  exposed. 

It  is  especially  as  therapeutic  measures  that  opera- 
tions are  necessitated  in  the  treatment  of  diseases  and 


SURGERY  IN  WOUND  TREATMENT        141 

injuries,  as,  for  example,  in  the  case  of  the  removal  or 
extirpation  of  diseased  or  altered  parts  whose  morbid 
action  injuriously  affects  the  general  health  or  pre- 
vents recovery  from  a  pre-existing  disease.  This  class  of 
operations  includes  the  opening  of  abscesses,  the  extirpa- 
tion of  gangrenous  parts,  or  of  necrosed  or  carious  bone; 
or  again,  for  the  modification  of  the  nature,  of  a  trau- 
matic lesion  in  order  to  stimulate  cicatrization,  as  in  the 
opening  of  a  fistulous  tract,  or  the  resection  of  an  ul- 
cerated surface,  or  when  the  tissues  are  to  be  relieved 
from  the  presence  of  a  foreign  body  or  the  abnormal  prod- 
uct of  a  natural  function,  as  in  case  of  esophagotomy, 
or  of  calculus  of  the  bladder,  or  of  the  salivary  ducts. 
Operations  have  also  their  prophylactic  uses,  especially  in 
the  various  forms  of  inoculation  and  vaccination  as 
anticipatory  and  preventive  of  infectious  diseases.  They 
find  their  further  obvious  indications,  again,  in  remedy- 
ing phj^sical  lesions  when  applied  to  fractures,  disloca- 
tions, deformities,  and  the  endless  list  of  accidental  in- 
juries, wounds,  and  hurts  of  every  kind  and  degrees. 
And  finally,  they  have  their  justifiable  use  in  mutilating 
the  larger  domestic  animals  designed  for  purposes  of 
labor  as  beasts  of  burden  or  draft  in  improving  their 
adaptability  by  castration  or  spaying,  or,  as  it  is  com- 
monly termed,  "altering." 

Thus  the  general  purpose  of  an  operation  is  to  palliate, 
cure,  or  assist  in  the  recovery  of  surgical  diseases;  to 
prevent  disease,  and  to  so  modify  the  condition  of  the 
domesticated  animals  as  to  enhance  their  usefulness  and 
value  to  their  human  owners. 

To  accomplish  these  ends  we  do  not  depend  upon 
surgery  alone,  but  also  employ  such  agents  as  setons, 
sutures  and  bandages,  drainage  tubes,  and  antiseptics. 
To  the  mechanical  appliances  we  need  not  devote  any 
time,  as  all  veterinarians  are  familiar  with  their  use,  but 


142  WOUND  TREATMENT 

the  use  of  antiseptics  and  biological  products  differs 
greatly  in  the  practice  of  veterinarians. 

The  use  of  medical  agencies  in  the  treatment  of  wounds 
depends  upon  the  character  of  the  wound  and  the  nature 
of  the  bacteria  that  may  have  or  that  have  gained  access 
to  the  wound.  A  solution  of  continuity  may  be  of  almost 
any  shape  or  form  imaginable  and  from  a  clean  incision 
to  a  ragged,  dirty,  lacerated  wound,  located  in  any 
region,  tissue,  or  organ  of  any  part  of  the  organism. 

These  variations  make  it  imperative  on  the  part  of  the 
operator  or  veterinarian  to  exercise  wide  judgment  in 
connection  with  his  theoretical  training,  since  various 
complications  (such  as  exposed  tendons,  open  joints,  a 
puncture  into  the  abdomen  or  thoracic  cavity)  require 
treatment  peculiar  to  the  extent  and  character  of  the 
lesion.  The  wound,  being  made,  the  operator  recalls  the 
ways  by  which  the  pathogenic  bacteria  may  enter  into  it, 
— by  the  air,  by  the  hands  and  clothing  of  the  operator, — 
or  by  means  of  foreign  bodies  (stone,  sand,  nails,  wood 
splinters,  pieces  of  earthenware)  which  enter  the  wound 
simultaneously  with  the  wounding.  Then  the  resting 
place  of  the  patient,  either  during  the  operation  or  after- 
wards, may  be  such  as  to  infect  the  wound,  or  infection 
may  come  by  means  of  the  instruments  and  bandaging 
material,  or  from  the  region  surrounding  the  wound 
(skin,  hair,  nails,  hoof). 

If  an  operator  makes  a  fresh  wound,  he  first  considers 
by  what  mode  and  by  what  means  he  can  prevent  the 
infection  of  the  wound,  and  if  the  wound  has  been  pre- 
viously made,  he  considers  how  he  is  to  remove  an  infec- 
tion already  existing  in  it. 

Therefore  we  have  two  different  subjects  to  consider, 
according  to  whether  the  wound  is  already  infected  or 
not.  If  our  aim  is  to  protect  a  wound  against  infection 
we  speak  of  aseptic  treatment  of  wounds,  while  disin- 


SURGERY  IN  WOUND  TREATMENT        143 

fecting  or  antiseptic  treatment  of  wounds  is  referred  to 
when  an  already  infected  wound  has  to  be  liberated 
from  the  infection — that  is,  disinfected  or  made  aseptic. 

We  therefore  should  not  be  surprised  that  the  rem- 
edies used  for  the  prevention  of  wound  infection  are 
entirely  different  from  those  used  for  the  removal  of  an 
infection  already  present ;  hence  the  remedies  used  in  the 
treatment  of  wounds  are  divided  into  two  groups:  first, 
bandaging  material ;  and  second,  disinfectants.  Bandage 
materials  should  possess  certain  qualities  to  obtain  the 
desired  effect.  First,  they  must  be  porous  so  as  to 
absorb  the  discharges  of  the  wound;  second,  they  must 
be  free  from  infectious  germs,  so  as  not  to  be  a  source  of 
infection  to  the  wound ;  third,  they  must  be  soft,  elastic, 
and  flexible,  so  as  not  to  cause  pressure  on  the  wound, 
and  must  adapt  themselves  to  the  corresponding  parts  of 
the  body  without  forming  any  gaps.  If  there  are  "no 
infectious  germs  already  present  in  the  wound  their  in- 
troduction is  most  liable  to  take  place  from  the  outside. 
To  avoid  this,  the  bandaging  material  should  be  impreg- 
nated with  some  reliable  disinfectant  so  as  not  to  per- 
mit of  infections  gaining  access  to  the  open  surface  of 
the  wound.  By  this  means  the  germs  that  may  gain 
access  into  the  bandage  material  are  destroyed  or  find 
that  the  discharges  absorbed  by  the  bandages  are  unfit 
as  a  nutritive  medium  for  their  development. 

Disinfection  means  nothing  else  than  the  removal  or 
destruction  of  the  germs  or  infection.  Disinfection  of 
wounds,  or  of  an  instrument,  or  of  the  operating  field, 
the  air,  hands,  and  clothing,  ligature  and  drainage  tubes, 
stable  and  resting  places,  means  making  innocuous  the 
infectious  germs  located  in  the  respective  media  that 
may  bring  them  in  contact  with  the  wound.  Most  dis- 
infectants act  simultaneously  in  two  or  more  ways,  and 
Ave  may  divide  the  methods  into  three  groups:     First, 


144  WOUND  TREATMENT 

physical  disinfection  agents;  second,  cliemical  disinfec- 
tion agents;  and  third,  biological  disinfection  agents. 

Among  the  physical  agents  we  class  all  surgical  instru- 
ments by  the  aid  of  which  we  can  remove  infected  ma- 
terial in  a  purely  mechanical  way,  such  as  the  knife,  scis- 
sors, or  sharp  spoon ;  also  the  high  degree  of  heat  in  the 
form  of  the  firing  iron  or  thermocautery,  and  finally  the 
withdrawal  of  moisture — namely,  exsiccation  and  perma- 
nent irrigation. 

The  chemical  agents  hostile  to  the  development  of 
micro-organisms  are  principally  mercuric  chlorid,  iodin, 
iodoform,  iodol  and  iodin  trichlorid,  carbolic  acid,  creolin, 
salicylic  acid,  boric  acid,  chlorid  of  zinc,  camphor,  tar, 
turpentine,  bismuth  subnitrate,  salol,  and  many  other 
similar  mediums  and  prepared  preparations 

The  biological  products  or  bacterins  help  in  disinfect- 
ing a  wound  by  assisting  the  animal  organism  in  destroy- 
ing the  infectious  bacteria.  This  once  accomplished,  the 
tissues  proceed  to  make  repair,  and  in  the  course  of  due 
time,  if  new  formations  foreign  to  the  part  do  not 
develop,  the  desired  effect  will  be  accomplished. 


PRACTICAL  SURGICAL  CLEANLINESS 

By  MART  R.  STEFFEN,  V.S.,  M.D.C.,  Brillion,  Wisconsin 

There  is  now  an  apparent  tendency  among  surgeons, 
both  human  and  veterinary,  leading  in  the  direction  of 
a  sane,  practical  balance  in  the  conception  of  surgical 
cleanliness. 

As  with  many  other  good  things,  so  also  with  our 
ideas  of  sepsis  and  asepsis,  extremes  have  been  developed 
and  accepted  which  we  are  now  endeavoring  to  adjust. 
The  treatment  of  fresh,  accidental  wounds  seems  to  afford 
the  best  field  for  the  application  of  new  and  improved 
thought  along  these  lines,  and  the  main  point  which 
nearly  all  writers  attempt  to  carry  in  recent  articles  is, 
that  the  assumption  of  microhian  contamination  in  all 
wounds  of  an  accidental  nature  is  erroneous.^  Almost 
without  exception  the  various  contributors  to  medical 
and  surgical  papers  dealing  with  this  subject  condemn 
the  doctrine  which  has,  until  recently,  been  generally  ac- 
cepted and  which  held  that  all  accidental  wounds  were 
to  be  treated  as  infected  wounds.  The  result  is  that  the 
treatment  of  wounds  is  undergoing  a  change,  especially 
as  regards  the  excessive  washing  and  irrigating  with  anti- 
septic solutions.  It  is  pointed  out  that  such  washing  and 
irrigating  is  detrimental  for  two  chief  reasons ;  one,  that 
it  always  devitalizes  the  tissues;  the  other,  that  it 
mechanically  removes  the  bacteriolytic  exudate  that  ap- 
pears almost  instantly  on  all  wounds — nature's  means 
of  controlling  whatever  infection  might  be  present.     Dr. 

^See  also  the  chapter  on  open  joints  in  my  boolc,  Special  Veterinary 
Therapif,  p.  W. 

145 


146  WOUND  TREATMENT 

W.  W.  Grant,  speaking  of  handling  wounds  that  accom- 
pany fractures,  says : 

"At  the  present  time  it  is  not  considered  advisable  to 
enlarge  the  wound  or  to  irrigate,  unless  dirt  or  some  in- 
fective material  is  in  the  wound.  The  old  maxim,  which 
considered  every  compound  fracture  as  infected,  is  not 
sound  nor  borne  out  in  practice." 

In  an  article  on  wound  and  skin  sterilization  Dr.  Lile 
says,  in  the  International  Journal  of  Surgery:  ''The 
plan  adopted  by  the  writer  in  all  cut,  bruised  or  lacer- 
ated w^ounds  is  never  to  wash,  but  before  allowing  any- 
thing to  come  in  contact  with  the  wound  to  swab  it  off 
with  the  five-per-cent  tincture  of  iodin  and  cover  with 
sterile  gauze." 

While  the  foregoing  remarks  are  mainly  in  reference 
to  human  surgery,  veterinary  surgeons  can  afford  to  pay 
some  attention  to  them.  Excessive  washing  of  w^ounds 
is  the  rule  in  veterinary  practice,  and  no  doubt  works 
as  adversely  in  our  patients  as  it  does  in  human  beings. 
One  hindrance  to  an  ideal  handling  of  wounds  in  our 
patients,  especially  equine  patients,  is  the  tendency  to- 
ward exuberant  granulations,  or  "proud  flesh,"  as  it  is 
commonly  called.  It  is  my  opinion,  formed  through  prac- 
tical experience,  that  this  tendency  is  aggravated  by 
much  washing  or  other  applications,  such  as  irrigating 
with  antiseptic  solutions. 

Referring  to  the  sterilization  of  the  unbroken  skin  for 
surgical  incision.  Dr.  Lile  says  in  the  same  paper,  "In 
operating  where  the  skin  is  unbroken  the  surface  is  first 
painted  with  gasolin  or  benzin,  then  dried  with  sterile 
gauze  or  a  towel,  and  painted  with  the  standard  iodin 
solution,  and  the  patient  is  ready."  He  also  remarks 
that  to  Grossich  is  due  the  credit  of  bringing  iodin  dis- 
infection to  its  present  scientific  basis  and  that  he  has 
"called  attention  to  the  fact  that  thorough  sterilization 


PRACTICAL  SURGICAL  CLEANLINESS     147 

could  be  obtained  only  when  the  iodin  solution  was  ap- 
plied to  a  dry  surface." 

From  personal  experience  with  this  method  of  steriliz- 
ing the  skin  previous  to  surgical  operations  I  can  say 
that  it  is  equally  safe  and  sufficient  in  veterinary  prac- 
tice if  the  hair  is  first  shaved  off. 


VULNERARIES  ' 

By  DOUGLAS  H.  STEWART,  M.D.,  New  York 

The  days  before  antisepsis,  treatment  of  wounds,  so 
far  as  dressing  was  concerned,  made  its  demands  upon 
the  patient's  own  healing  powers,  which  were  to  be  aided 
b}^  vulneraries.  Then  came  the  Pasteur-Lister  methods, 
which  aided  the  patient  not  at  all,  considered  the  wound- 
healing  application  of  small  account,  but  did  interpose  a 
shield  between  the  patient  and  extraneous  infection. 
About  the  year  1895  there  appeared  the  experimental 
work  of  some  German  surgeons,  who  claimed  that  the 
use  of  antiseptics  in  infected  wounds  was  of  no  benefit. 
For  centuries  there  had  been  in  use  a  plant  known  as 
bruisewort.  Modern  men  were  experimenting  with  pla- 
cental membranes.  Now  the  consensus  of  opinion  is  that 
wounds  require  both  the  shield  of  the  dressing  and  the 
reinforcement  of  the  patient's  bactericidal  products. 

The  value  of  the  vulnerary  begins  where  the  surgeon 
leaves  off,  and  bruisewort,  or  comfrey,  had  been  more 
or  less  in  use  for  ages.  Nor  can  any  one  who  has  had 
experience  with  this  plant  be  persuaded  that  it  does  not 
possess  tissue-building  powers.  Neither  is  it  strange  that 
those  powers  should  be  sought  for  in  embryotic  tissues, 
because  the  active  principle  of  placental  membranes  as 
well  as  of  Symphytum  officinale  (that  is,  comfrey)  is 
allantoin.  German  literature  treats  approvingly  of  that 
plant  as  a  wound-healer,  and  personal  experiment  con- 
firms the  good  results  claimed  therein.  The  Americans 
claim  that  comfrey  will  cause  the  disa])pearance  of  sar- 


iltoprinted   from   The  Ai7icrican  Journal  of  Clinical   Medicine. 

149 


150  WOUND  TREATMENT 

coma.  I  do  not  believe,  because  I  do  not  know ;  but,  not 
knowing  I  have  not  the  recklessness  to  say,  "Impossible." 

Nature's  usual  first  step  in  healing  an  incised  wound 
is  to  discharge  a  thin  serous  fluid.  Attempts  at  aiding 
this  first  step  are  made  by  using  an  "osmotic  pump"; 
that  is,  by  applying  some  substance  of  high  specific  grav- 
ity in  which  an  antiseptic  is  dissolved,  and  anticipating 
that  germs  carried  out  of  the  tissues  will  be  killed  as  are 
those  of  external  origin.  Hence,  glycerin  and  its  combi- 
nations were  used,  and  later  sodium  chlorid  was  similarly 
employed.  This  salt  regulates  osmosis  and  imitates  some 
of  the  functions  of  blood  serum.  Other  sodium  or  potas- 
sium salts  were  mixed  with  the  sodium  chlorid  until 
finally  Wright,  of  England,  mentioned  the  advantages 
of  the  citrate. 

Wright's  solution  has  been  widely  and  successfully 
used;  but  it  is  really  a  wound-healer,  pure  and  simple, 
and  is  devoid  of  any  gerniicidal  value.  It  compares  well 
with  allantoin,  and,  in  view  of  the  raging  European  war, 
is  much  more  accessible.  It  does  seem  as  if  the  vulnerary 
had  come  into  its  own  again,  after  all ;  at  the  same  time, 
the  lessons  learned  from  the  wave  of  antisepsis  are  many 
and  important. 

Suppose  one  were  to  secure  a  vulnerary  which  was  at 
the  same  time  a  germicide,  yet  free  from  the  drawbacks 
called  irritation.  Suppose  a  mixture  existed  which  was 
sedative  to  tissues  and  attacked  neither  skin  nor  instru- 
ment. Suppose  this  preparation  would  take  care  of 
vaginal  or  dormal  injuries  so  far  as  redness,  heat,  pain, 
swelling,  and  discharge  were  concerned.  Suppose  a  sur- 
geon could  employ  it  equally  well  to  treat  vaginal  gonor- 
rhea or  a  septic  or  an  aseptic  wound,  or  use  it  on  his 
own  face  after  shaving.  Then  it  might  well  ])e  called 
the  surgeon's  own  powder,  especially  if  it  were  odorless. 

There  is  such  a  combination,  whic^h,  when  it  is  brought 


VULNEEARIES  151 

in  contact  with  an  animal  fluid  or  discharge,  at  once 
breaks  up  into  Wright's  solution,  plus  aluminum  acetate, 
plus  insoluble  white  lead ;  and  its  results  are  exactly  what 
any  one  would  imagine  they  would  be  when  backed  up 
by  the  most  powerful  osmotic  pump  known ;  namely,  cane 
sugar,  which  compares  with  glycerin  as  1,600  to  1,250  or 
less. 

The  experimentation  which  led  up  to  this  combination 
of  wound-healer  and  protector  would  make  many  papers 
such  as  this  one.  There  seems  to  be  some  difficulty  in 
making  the  preparation;  however,  the  power  machines 
experience  no  trouble.  Consequently  it  would  appear  to 
be  a  qviestion  of  trituration.  Its  formula  for  general  use 
should  be  as  follows : 

Sublimate    grs.  2 

Sodium    citrate grs.  40 

Sodium   chlorid grs.  240 

Alum    grs.  180 

Lead  acetate grs.  360 

Sugar,  enough  to  make ozs.  16 

Since  writing  the  above,  I  have  heard  that  some  are 
using  this  compound  either  before  or  after  the  usual 
hand-cleansing  procedure,  as  it  keeps  the  operator's 
hands  soft  and  pliable.  Personally,  after  returning  home 
from  an  operation  I  make  it  a  habit  to  take  a  teaspoonful 
of  the  powder  in  my  hands,  rub  it  in  thoroughly  (it  gets 
wet  by  rubbing),  leave  it  on  for  five  minutes,  and  then 
wash  it  off  with  cool  water. 


PRACTICAL  WOUND  APPLICATIONS 

By  A.  W.  WALDRON,  JR.,  D.V.S.,  Tullahoma,  Tennessee 

AYhile  aseptic  surgery  is  ideal  it  is  far  beyoud  the  at- 
tainment of  the  country  practitioner  in  a  location  such 
as  this,  where  the  farmers  clean  their  stables  but  once  a 
year. 

Undeniably,  all  antiseptics  irritate  wounds  and  retard 
healing :  but  their  use  is  imperative,  and  furthermore  the 
dressing  must  be  as  simple  as  possible  to  apply,  and 
should  require  but  little  of  the  attendant 's  time.  For  as 
a  rule  elaborate  directions  will  not  be  followed. 

Each  year  I  use  less  bichlorid  and  more  tincture  of 
iodin,  which  is  I  tliink  the  best  application  for  the  great 
majority  of  wounds,  both  surgical  and  accidental.  Ap- 
plied once  a  day  with  a  swab  or  syringe,  and  later  every 
second  or  third  day,  its  effects  are  most  satisfactory. 
The  pain  its  application  occasions  is  ephemeral.  By  its 
use  we  obtain  most  of  the  benefits  of  iodoform,  without 
the  oft'ensive  odor  and  at  far  less  expense  than  we  could 
use  the  powder.  An  application  of  100  parts  fish  oil, 
50  parts  oil  of  tar,  and  1  part  carbolic  acid,  or  the  com- 
mon "black  oil,"  a  petroleum  product,  will  protect  the 
wound  from  flies.  Either  one  is  both  inexpensive  and 
effective.  Paint  around  the  wound  with  one  of  the 
above  three  times  a  day. 

Iodin  is  most  excellent  for  the  general  purposes  of  the 
countrj^  practitioner,  whose  methods  must  almost  always 
be  more  or  less  rough  and  ready.  It  is  a  useful  applica- 
tion to  the  points  of  sutures,  for  sterilizing  a  line  of  in- 
cision, and  as  an  application  to  many  forms  of  contused 

153 


154  WOUND  TREATMENT 

as  well  as  lacerated,  punctured,  and  incised  wounds. 
This  refers  alike  to  wounds  in  muscular,  tendinous,  and 
osseous  structures.  Under  this  treatment  large  and  deep 
wounds  will  remain  practically  dry  if  made  under  rea- 
sonably good  aseptic  precautions. 

For  w^ounds  in  the  oral,  abdominal  and  the  other  nat- 
ural cavities,  hydrogen  dioxid  is  my  favorite  antiseptic, 
either  full  strength  or  diluted  and  used  ad  libitum. 

For  surface  wounds,  and  where  it  is  desirable  to  pro- 
duce a  dry  scab  as  quickly  as  possible,  as  in  "broken 
knees,"  there  is  nothing  equal,  I  believe,  to  tannoform; 
for  persistent  uraehus  this  is  also  very  valuable,  often 
relieving  the  condition  in  forty-eight  hours,  if  applied 
every  three  hours  to  the  umbilicus  in  sufficient  quantity 
to  cover  the  area  rather  thickly. 

For  surface  wounds  where  the  cost  of  the  dressing  is 
more  of  an  object,  an  absorbent  mildly  antiseptic  and 
astringent,  dusting  powder  often  answers  well.  All  of 
the  above  dressings  are  most  efficiently  and  economically 
applied  by  means  of  the  small  insect-powder  blowers  to 
be  obtained  from  druggists. 

Pulverized  copper  sulphate  quickly  destroys  the  exces- 
sive quantities  of  granulation  tissue  so  frequently  found 
in  old  and  neglected  wounds. 

As  a  protective  dressing  to  open  wounds  that  are  sup- 
purating but  little  in  seasons  of  the  year  when  flies  are 
bothersome,  the  following  prescription  does  very  well. 
It  is  particularly  applicable  to  wire  cuts  and  other  lacer- 
ated wounds. 

oz. 

Phenol 1 

Gum  camphor  5 

Eesin    1 

Methylated   spirits    15 

M.     Sig.     Paint  on  wounds  three  or  four  times  a  day. 


ABDOMINAL  WOUNDS  OF  ANIMALS' 

By  J.  V.  LACROIX,  D.V.S.,  Kansas  City 

Under  abdominal  wounds  of  animals  may  be  included 
a  wide  range  of  conditions  wherein  divers  factors  are  to 
be  reckoned  with.  In  this  brief  treatise  we  shall  con- 
sider the  subject  in  a  general  way  only,  mentioning  spe- 
cific instances  in  the  way  of  case  reports  merely  for 
emphasis. 

Our  domestic  animals  are  all.  because  of  the  manner 
in  which  they  are  kept,  subject  to  injuries  of  the  abdo- 
men. In  a  general  way  the  horse  and  mule  are  more 
frequently  affected  than  are  the  other  animals.  The 
fact  that  horses,  used  as  they  are  in  aU  kinds  of  service, 
exposed  to  various  injuries  in  the  way  of  runaway  acci- 
dents, kicking  one  another  when  shod  with  calked  shoes ; 
together  with  the  anatomical  construction  of  the  abdom- 
inal wall,  accounts  for  their  being  frequently  injured. 
The  abdominal  waU  of  the  horse  is  more  tense  than  is 
that  of  other  animals,  and  being  ver^'  agile  and  quite 
likely  to  struggle  whenever  any  ^-ulnerable  object  con- 
tacts the  abdomen,  they  are  often  seriously  injured.  The 
ox,  under  the  same  conditions,  would  suffer  little  or  no 
harm. 

Cattle  receive  abdominal  wounds  rather  infrequently. 
They  are  subjected  to  contusions  probably  more  fre- 
quently than  to  any  other  mode  of  injure-.  Having  thick 
skin  and  a  rather  loose  and  pliable  abdominal  wall,  punc- 
tures and  lacerations  are  of  comparative  inf requency. 


^Read  at  the  50th  annual  meeting^  of  the  American  Veterinary 
Medical  Association. 

155 


156  WOUND  TREATMENT 

Sheep  have  loose  abdominal  walls,  and  in  addition  the 
'.kin  is  protected  by  wool.  Abdominal  fat  is  usually 
quite  abundant,  and  as  sheep  are  not  inclined  to  greatly 
resist  confinement  in  any  position^  they  seldom  suffer 
from  injuries  of  the  abdominal  walls. 

Neither  are  swine  frecpiently  the  victims  of  abdominal 
wounds,  though  brood  sows  with  large,  pendent  abdomens 
receive  lacerations  of  the  mammary  glands  occasionally, 
and  various  complications  may  ensue.  This  is  the  most 
frequent  form  of  injury  among  these  animals.  Swine 
may  wound  one  another  in  combat,  or  receive  wounds 
from  dogs  or  wolves,  but  this  is  not  of  frequent  occur- 
rence. Having  more  or  less  fat  underlying  the  skin,  they 
may  receive  extensive  and  deep  wounds  without  making 
eventration  imminent  or  necessarily  a  sequel,  the  result 
of  a  post  traumatic  necrosis  of  tissue. 

Abdominal  wounds  are  classified  variously  by  different 
authorities.  We  shall  for  convenience  here  consider 
them  under  four  classifications,  as  follows: 

1.  Contusions  with  subsurface  solution, 

2.  Lacerations  without  eventration. 

3.  Wounds  with  eventration  and  without  visceral  perforation. 

4.  Penetrant  wounds  with  visceral  perforation. 

Contusions  with  Subsurface  Solution  of  Continuity 

Contusions  with  subsurface  maceration  of  tissue  fre- 
quently occur  in  horses  and  mules.  This  type  of  injury 
is  occasioned  by  any  heavy  blow  that  is  sufficiently  force- 
ful to  sever  any  one  of  the  several  layers  comprising  the 
abdominal  parietes.  Contusions  are  so  directed  as  to  dis- 
place relations  of  the  various  layers  of  the  abdominal 
wall,  by  rupturing  tissue,  allow  of  considerable  extrava- 
sation of  blood  and  serum.  Such  injuries  are  accom- 
plished by  falls  or  kicks,  or  ])y,  the  animal  being  crowded 
against  door  jambs  or  gate  posts,  or  bunted  by  cow's 
horns. 


ABDOIMINAL  WOUNDS  OF  ANIMALS      157 

]\Ianifestatioii  of  such  injuries  may  be  evident  within 
a  few  hours  after  they  occur,  or  they  may  pass  unno- 
ticed until  much  subsurface  extravasation  or  discharge 
of  fluids  has  taken  place.  In  some  cases,  only  a  small 
amount  of  blood  escapes  into  the  tissues,  little  swelling 
occurs  at  first,  and  not  until  infection  has  taken  place  is 
there  marked  inconvenience  manifested  by  the  subject. 
Abscesses  occurring  in  this  manner  often  contain  large 
quantities  of  pus,  and  it  is  a  noticeable  fact  that  such, 
conditions  may  persist  for  weeks  at  a  time  without  per- 
foration of  the  abdominal  wall  from  necrosis. 

To  differentiate  between  abscess  of  the  abdominal  wall 
where  there  exists  a  large  cavity  filled  with  fluctuating 
detritus,  and  hernia,  is  not  easy  in  certain  cases.  In 
vicious  horses,  where  the  condition  is  painful,  little  is 
to  be  learned  by  palpation  w^hile  the  subject  is  standing. 
By  casting  such  animals  and  placing  them  in  such  a  posi- 
tion that  the  swelling  is  located  uppermost,  one  can  ex- 
clude hernia  by  absence  of  perforation  of  the  underlying 
structures,  and  failure  at  reduction  of  the  mass.  Finally, 
by  using  an  exploratory  trocar  or  needle,  hernia  can  be 
excluded. 

Where  such  abscesses  involve  one  or  more  floating  ribs, 
necrosis  is  likely  to  result  in  perforation  of  the  abdom- 
inal wall,  and  being  situated  nearer  the  superior  part  of 
the  abdomen,  swelling  is  not  so  extensive  and  it  is  more 
defined. 

Treatment  of  such  cases  consists  in  evacuation  of  all 
pus  and  the  removal  of  shreds  of  necrotic  tissue.  Such 
abscesses  should  be  so  opened  that  perfect  drainage  may 
take  place  and  little  after-care  be  necessary. 

An  extreme  case  of  this  kind  was  treated  by  the  writer 
in  1906.  The  subject  was  a  gelding  weighing  eleven  hun- 
dred pounds.  He  was  very  vicious,  and  the  owner  had 
given  him  little  or  no  attention.     Not  until  the  swelling 


158  WOUND  TREATMENT 

had  gTadually  increased  for  about  six  weeks  was  any 
attention  given  the  case.  Location  of  the  enlargement 
was  in  the  left  flank,  and  it  extended  from  the  umbilicus 
to  near  the  anterior  iliac  tuberosity.  The  fluctuating 
center  was  about  twelve  inches  in  diameter.  It  was  not 
possible  to  determine  the  exact  nature  of  the  condition 
without  casting  the  animal.  After  properly  confining 
the  subject,  diagnosis  was  not  difficult.  The  abscess  was 
drained  of  a  large  quantity  of  pus  and  the  cavity  irri- 
gated with  a  weak  antiseptic  solution.  The  subject  was 
allowed  exercise,  but  in  about  a  week  it  became  necessary 
to  enlarge  the  opening  made  for  drainage.  The  animal 
being  hard  to  handle,  no  further  treatment  was  given 
him,  and  complete  recoVery  resulted  in  about  a  month. 

Traumatisms  immediately  resulting  in  hernia,  with 
more  or  less  subsurface  laceration  of  tissue,  are  met  with 
frequently  in  all  animals.  Contusions  produced  by 
means  of  blunt  objects  often  result  in  hernia  because  the 
skin  is  freely  movable,  and  quite  capable  of  withstanding 
injuries  which  do  violence  to  the  underlying  tissues. 
Subcutaneous  rents  result  in  hernia  where  a  sufficient 
opening  in  the  abdominal  wall  is  produced.  Strangula- 
tion of  intestine  may  occur,  and  unless  cared  for,  results 
fatally.  Strangulation  usually  occurs  where  the  injuries 
involve  the  region  of  the  groin.  Non-strangulated 
hernias  are  often  found  involving  the  floor  of  the  abdo- 
men anterior  to  the  inguinal  region. 

No  great  difficulty  is  experienced  in  making  a  diag- 
nosis of  such  cases,  as  they  occur  in  connection  with  some 
injury  and  the  skin  usually  bears  evidence  of  violence, 
even  though  it  be  left  intact.  By  rectal  examination 
those  parts  of  the  abdominal  wall  that  are  within  reach 
may  be  palpated  and  the  nature  of  the  swelling  deter- 
mined. Where  strangulated  hernia  exists,  diagnosis  is 
not  so  easily  made  as  in  cases  of  non-strangulated  hernia. 


ABDOMINAL  WOUNDS  OF  ANIMALS       159 

Treatment  is  imperative  in  cases  of  strangulated  hernia 
and  consists  in  confinement  and  anesthetization  of  the 
subject.  The  skin  over  the  swelling  is  shaved  and 
cleansed  with  soap  and  water,  dried,  and  painted  with 
tincture  of  iodin.  A  free  incision  is  made,  exposing  the 
strangulated  loop  of  intestine  and  the  ragged  edges  of 
the  subcutaneous  wound.  Reposition  is  effected  by  ma- 
nipulation, after  having  drained  a  quantity  of  fluid  with 
a  small  trocar.  If  little  fluid  is  contained,  it  may  be 
necessary  to  enlarge  the  opening  slightly.  After  reduc- 
ing the  hernia,  approximation  of  the  wound  margins  is 
effected  by  means  of  sutures. 

In  a  case  of  strangulated  hernia  occurring  in  a  twelve- 
hundred  pound  mule,  the  animal  had  kicked  over  a  par- 
tition and  become  impaled  upon  an  upright  timber.  In 
his  struggles  a  sufficient  amount  of  tissue  had  been  torn 
and  badly  mutilated  to  allow  a  hernia  of  the  floating 
colon.  Separation  of  muscular  layers  had  taken  place  to 
an  extent  sufficient  to  permit  of  the  incarceration  of 
about  twenty  inches  of  intestine. 

The  writer  was  called  about  four  hours  after  the  acci- 
dent occurred.  At  that  time  there  existed  in  the  left 
flank  just  anterior  to  and  below  the  anterior  iliac  spine 
an  enlargement  ten  or  twelve  inches  in  diameter,  which 
was  edematous  in  its  periphery.  Manipulation  of  the 
mass  caused  pain  to  the  subject.  By  rectal  examination 
it  w^as  possible  to  outline  the  irregular  borders  of  this 
abdominal  rent.  The  animal  was  very  restless,  and  it 
was  decided  that  immediate  surgical  intervention  w^as 
the  only  recourse. 

With  assistance,  the  subject  w^as  cast,  and  anesthetized, 
the  field  prepared,  and  bj^  means  of  a  free  incision  the 
strangulated  loop  of  bowel  was  exposed  and  replaced. 
The  wound  was  prepared  and  the  various  tissue  layers 
were  sutured  separately.    The  mule  was  allowed  the  free- 


160  WOUND  TREATMENT 

dom  of  a  small  blue-grass  pasture,  and  beyond  some  sup- 
puration which  later  necessitated  drainao:e,  a  complete 
and  uneventful  recovery  resulted. 

Laceration  Without  Eventration 

Laceration  of  some  part  of  the  abdominal  wall  without 
eventration  is  of  common  occurrence  and  is  caused  in 
numerous  ways.  Because  of  the  fact  that  fibres  of  the 
several  muscular  layers  of  the  abdominal  w^all  are  dis- 
posed in  various  directions,  large  wounds  occur  without 
complete  perforation.  This  is  particularly  true  when  the 
offending  implement  is  not  possessed  of  a  keen  edge  or  a 
sharp  point.  Horses  are  kicked  by  others  that  are  w^ear- 
ing  sharp  calked  shoes,  receiving  extensive  lacerations, 
but  it  is  unusual  for  the  victims  of  this  mode  of  injury 
to  suffer  eventration  at  the  time  of  accident.  In  jump- 
ing over  and  upon  fences,  lacerations  of  the  abdominal 
wall  occur ;  but  unless  the  animal  strikes  an  upright  body 
capable  of  penetrating  the  abdomen,  extensive  lacerations 
usually  take  place  without  immediate  eventration. 

Lacerations  of  the  abdominal  wall  are  characterized  by 
visible  solution  of  continuity,  fragmentary  protrusion  of 
margins,  and  more  or  less  hemorrhage.  Because  of  the 
facility  with  which  separation  of  tissue  layers  takes  place, 
sacculations  are  to  be  found  under  the  margins  of  the 
wound;  these  extend  in  various  directions,  and  wdiere 
gravitation  or  pressure  does  not  interfere,  they  are  tilled 
with  blood. 

Where  such  w^ounds  are  not  too  deep,  and  conditions 
make  impracticable  other  and  more  elaborate  treatment, 
they  may  be  cared  for  b}^  trimming  away  all  macerated 
tissue,  controlling  the  hemorrhage,  and  further  dressing 
them  as  open  wounds. 

Where  such  lacerations  are  deep  and  involve  so  uuich 


ABDOMINAL  WOUNDS  OF  ANIMALS      161 

tissue  that  eventration  threatens,  coaptation  of  the  wound 
margins  in  some  manner  is  necessary. 

In  the  handling  of  such  cases  in  large  animals,  the 
first  problem  which  confronts  the  operator  is  that  of 
restraint.  Certain  it  h  that  the  subject  must  be  con- 
fined, and  unless  the  Avound  is  high  up  on  the  side,  a 
recumbent  position  is  necessary.  As  a  precautionary 
measure  it  is  well  to  apply  a  temporary  bandage  to  pro- 
tect and  support  the  parts  until  the  animal  is  placed  in 
readiness.  If  much  suturing  is  to  be  done,  complete 
anesthesia  is  imperative.  Local  anesthesia  would  suffice 
were  it  not  that  the  subject  usually  resists  confinement 
even  more  than  the  pain  inflicted  by  the  process  of 
suturing. 

Since  the  treatment  of  such  wounds  constitutes  emer- 
gency surgery,  there  is  no  time  for  the  preparation  of 
the  subject,  and  one  must  count  on  an  occasional  loss 
from  anesthesia,  delirium,  or  shock. 

Careful  attention  must  be  given  to  cleansing  the  skin 
bordering  the  wound.  A  liberal  area  should  be  shaved, 
all  macerated  tissue  removed,  and  the  wound  thoroughly 
cleansed  by  mopping  with  gauze  or  cotton  moistened  with 
a  mild  antiseptic  solution,  or  with  sterile  water.  After 
hemorrhage  has  been  controlled,  all  parts  should  be 
moistened  with  tincture  of  iodin.  Particularly  is  this 
essential  if  the  wound  has  taken  place  several  hours 
prior  to  its  being  treated,  or  if  it  has  contained  much 
dirt  or  filth. 

Approximation  of  the  wound  margins,  with  the  excep- 
tion of  the  skin,  may  be  brought  about  by  means  of  con- 
tinuous sutures  of  chromic  gut.  Each  of  the  several 
layers  of  tissue  comprising  the  abdominal  wall  should  be 
sutured  separately,  then  the  skin  should  be  sutured  with 
a  heavy  material  either  of  silk  or  linen.     Mattress  sutures 


162  WOUND  TREATMENT 

serve  very  well.  Reinforcing  sutures  in  the  skin  and  sub- 
cutem  are  useful  in  some  cases.  This  method  of  suturing 
is  applicable  in  all  cases  where  coaptation  is  attempted. 
Some  suppuration  occurs  in  the  majority  of  cases,  and 
drainage  should  be  provided  for  by  means  of  a  tube  or 
by  inserting  at  some  pendent  part  of  the  wound  a  suture 
that  is  readily  removed.  After-care  consists  in  keeping 
the  parts  clean  and  restricting  exercise.  Plenty  of  time 
should  be  allow^ed  that  complete  repair  may  take  place, 
else  hernia  is  likely  to  occur  even  three  or  four  months 
after  the  wound  has  completely  healed.  The  parts  may 
be  supported  by  means  of  heavy  bandage  material  during 
the  process  of  treatment,  but  it  is  doubtful  if  this  is  of 
real  service  if  the  wound  has  been  properly  sutured.  In 
large  animals  wounds  so  treated  are  completely  united 
within  thirty  days  unless  swelling  persists  and  consider- 
able necrosis  results. 

A  lacerated  wound  of  the  abdominal  wall  in  a  mule, 
the  result  of  a  kick  with  a  sharp  calked  shoe,  was  treated 
at  the  Kansas  City  Veterinary  College  in  January,  1911. 
The  injury  was  located  in  the  right  lower  abdominal  re- 
gion about  eight  inches  from  the  median  line  and  twelve 
inches  anterior  to  the  pubic  brim.  All  of  the  structures 
except  the  peritoneum  were  lacerated.  The  wound  ex- 
tended almost  at  a  right  angle  from  the  spinal  axis,  and 
was  about  five  inches  in  length.  Much  dirt  and  filth  had 
been  carried  into  the  depths  of  the  w^ound,  and  there  was 
extensive  maceration  of  tissue. 

The  animal  was  placed  upon  an  operating  table  and 
the  wound  treated  as  just  outlined.  Union  of  the  parts 
had  taken  place  in  about  three  weeks,  and  the  patient 
was  then  dismissed  from  the  hospital.  She  was  put  to 
heavy  work  at  a  grading  camp,  and  a  hernia  resulted. 
However,  this  did  not  interfere  with  her  usefulness,  but 


ABDOMINAL  WOUNDS  OF  ANIMALS       163 

was  the  direct  result  of  an  insufficient  length  of  time 
being  alloAved  for  complete  repair  to  have  taken  place 
before  putting  the  animal  in  service. 

Wounds  With  Eventration  and  Without  Visceral 
Perforation 

Wpunds  with  eventration  and  without  visceral  per- 
foration occur  in  all  animals,  the  result  of  direct  in- 
juries of  various  kinds.  The  agent  inflicting  such  in- 
juries is  not  sharp  enough  to  perforate  viscera  imme- 
diately upon  coming  in  contact  with  them,  even  though 
driven  with  great  force.  This  tj^pe  of  wound  occurs  in 
horses  that  are  gored  by  bovines,  or  become  impaled 
upon  upright  posts  or  implements  of  various  kinds.  The 
writer  has  observed  fatal  eventration  in  the  horse  where 
a  rent  at  least  eight  inches  in  length  was  inflicted  by  a 
Jersey  cow's  horn.  Where  much  of  the  intestine  pro- 
trudes it  is  likely  to  become  injured  beyond  repair,  un- 
less it  is  given  immediate  protection  in  some  manner 
until  reposition  is  effected.  Even  though  successful 
reposition  of  the  intestine  is  effected,  there  is  danger 
of  peritonitis,  and  considerable  shock  always  attends  in- 
juries of  this  kind.  Where  such  w^ounds  involve  the 
floor  of  the  abdomen  there  is  likelihood  of  hernia  re- 
sulting unless  it  is  possible  to  securely  approximate  the 
wound  margins. 

Treatment  consists  first,  in  protection  of  the  exposed 
viscera  and  appropriate  confinement  of  the  subject. 
After  thoroughly  cleansing  the  visceral  organs,  reposi- 
tion is  attempted.  In  the  large  animals,  if  there  is  much 
struggling  or  straining,  complete  narcosis  is  needed. 
Reinforcement  and  protection  of  the  wound  with  dress- 
ings and  bandages  is  helpful  in  small  animals,  and  may 


164  WOUND  TREATMENT 

be  of  some  advantage  in  the  large  animals.  However, 
where  such  wounds  are  kept  covered  they  remain  moist, 
and  are  prone  to  suppurate  unless  frequently  redressed. 

Penetrant  Wounds  With  Visceral  Perforations 

Visceral  perforation  occurs  occasionally  in  any  of  the 
domestic  animals  and  is  the  result  of  gunshot  wounds, 
thrusts  with  sharp  implements  of  any  sort,  or  where  ani- 
mals become  impaled  upon  sharp  projecting  bodies.  In 
the  smaller  animals  tooth  wounds  sometimes  penetrate 
the  intestine. 

Where  the  perforation  is  large  in  animals  that  resist 
manipulation  of  the  peritoneum,  it  is  possible  to  close 
the  intestinal  wound  by  means  of  bowel  anastomosis  or 
by  approximation  of  its  margins  with  sutures.  Spon- 
taneous marginal  adhesion  of  serous  membranes  with  the 
production  of  fecal  fistulse  is  not  of  uncommon  occur- 
rence. 

Where  small  puncture  wounds  involve  the  bowel  in 
numerous  places,  allowing  the  escape  of  intestinal  con- 
tents into  the  peritoneal  cavity,  there  is  no  effectual 
means  of  intervention  except  such  as  occasions  laparot- 
omy ;  therefore  the  repair  of  this  form  of  injury  is  often 
impracticable. 


OPEN  JOINTS 

By  J.  N.  Frost,  D.V.M.,  Ithaca,  N.  Y. 

The  literature  in  regard  to  suppurative  arthritis 
seems  to  be  a  minus  quantity  so  far  as  veterinary  sur- 
gery is  concerned,  and  the  case  reports  are  few.  As  one 
medical  work  states,  ''Our  knowledge  of  joint  disease  is 
so  imperfect  that  no  opportunity  should  be  lost  by  which 
clinical  data  may  be  added." 

Causes. — The  causes  of  open  joints  are  kick  wounds, 
nail  punctures,  and  the  like,  which  not  only  open  the 
joint  capsule  but  are  liable  to  carry  infection  to  the 
joint  cavity,  where  synovia  serves  as  a  favorable  medium 
for  the  development  of  the  bacteria.  Another  cause  is 
the  extension  of  necrosis  from  neighboring  areas  of  in- 
fection, such  as  tendon  sheaths  or  burs^e.  Likewise,  it 
may  result  by  the  process  of  metastasis  from  some  dis- 
tant suppurating  foci. 

The  severity  of  articular  wounds  is  not  due  to  the 
lesions  produced,  but  to  the  inoculation  of  the  wound 
with  bacteria.  When  pyogenic  organisms  gain  entrance 
to  a  joint  cavity  they  lead  to  inflammation  of  all  the 
structures  of  the  joint,  followed  by  suppuration,  and, 
unless  overcome,  to  the  destruction  of  the  joint  cartilage 
and  its  discharge  in  the  form  of  pus,  leaving  the  ends  of 
the  bones  bare  and  rough.  Naturally,  this  leads,  in 
those  joints  where  the  movement  is  limited,  to  ankylosis 
or  stiffness  of  the  joint. 

SYMPfOMS. — If  the  wound  of  the  joint  is  small,  and 
made  by  a  clean  instrument,  the  only  symptom  may  be 
the  discharge  of  synovial  fluid.    In  most  cases  there  will 

165 


166  WOUND  TREATMENT 

be,  however,  some  infection  which  results  in  signs  of  irri- 
tation, sneh  as  swelling  of  the  joint,  increased  synovial 
fluid,  or  tenderness  on  palpation.  If  the  infection  is 
severe  there  will  be  edema,  fever  as  high  as  104  to  105 
degrees,  with  pulse  and  respiration  increased.  The  pa- 
tient holds  the  swollen,  painful  articulation  in  a  posi- 
tion to  relieve  the  pain  as  much  as  possible,  touching 
only  the  toe  to  the  floor.  Frequent  convulsive  move- 
ments are  made  with  the  leg,  indicating  pain  in  the 
part.  The  tissues  surrounding  the  joint  are  inflamed 
and  swollen,  and  there  is  a  discharge  of  synovia  from 
the  wound,  which  at  first  is  a  slippery,  transparent, 
straw-colored  liquid.  Synovia  may  be  recognized  by  its 
tenacity  if  the  finger  which  touches  the  fluid  is  slowly 
withdrawn.  This  is  a  sure  sign  that  the  fluid  has  come 
from  a  synovial  bursa,  or,  in  other  words,  that  it  con- 
tains mucin. 

As  inflammation  of  the  joint  advances,  the  synovia 
is  discharged  in  thick,  heavy  clots.  After  the  synovial 
membrane  becomes  infected,  its  secretion  is  greatly  aug- 
mented, and  the  discharge  is, a  thick  yellow  mixture  of 
pus  and  synovia,  which  is  thrown  off  in  large  quantities. 

The  loss  of  flesh  is  exceedingly  rapid,  even  though  the 
appetite  remains  good.  Due  to  long  periods  of  decu- 
bitus, sore  and  infected  areas  develop  on  the  skin  over 
the  external  angle  of  the  ilium,  the  shoulder,  and  the 
supra-orbital  process  of  the  head. 

The  differential  diagnosis  between  a  suppurative  ar- 
thritis and  suppurating  tendon  sheath  is  not  always  easy, 
as  the  discharge  from  each  has  the  same  general  anpear- 
ance  and  around  most  of  the  joints  there  are  tendon 
sheaths  which  may  become  opened  more  readily  than  the 
joint.  There  is  usually  a  difference  in  the  degree  of 
lameness.  The  animal  with  open  tendon  sheath  does 
not  ordinarily  shoAv  as  great  pain   upon   movement  or 


OPEN  JOINTS  167 

upon  bearing  weight  on  the  part  as  does  the  animal 
with  open  joint. 

By  probing  we  can  usually  make  our  diagnosis  posi- 
tive. We  are  told  by  many  that  probing  should  not  be 
resorted  to,  and  this  no  doubt  is  true  if  it  cannot  be 
done  in  an  aseptic  manner.  We  fail  to  see,  however, 
why  there  should  be  danger  if  we  are  careful  to  dis- 
infect the  wound  and  then  use  a  thoroughly  sterilized 
probe.  After  probing  we  are  in  a  position  to  give  a 
more  accurate  prognosis  and  treatment. 

Treatment. — The  treatment  of  suppurative  arthritis 
is  highly  unsatisfactory,  necessarily  of  long  duration, 
and  in  a  great  percentage  of  cases  unsuccessful.  The 
death  rate  has  resulted  in  the  trial  of  drugs,  with  poul- 
tices, blisters,  continual  irrigation  with  weak  antiseptic 
solutions,  ointments  of  camphor,  alum,  calomel,  and  cor- 
rosive sublimate. 

In  the  treatment  of  open  joints,  they  may  be  divided 
into  two  groups : 

1.  Open   joints,    such    as    the    stifle,    shoulder,    or   elbow,    where 

ankylosis  cannot  occur,  or,  occurring,  would  destroy  the  use- 
fulness of  the  animal. 

2.  Open  joints  which,  if  ankylosed,  would  not  seriously  impair 

the  value  of  the  animal,  such  as  the  smaller  tarsal  joints  of 
the  corono-pedal  joint. 

The  first  question  to  be  decided  when  a  joint  is  in- 
volved in  acute  suppuration  is  whether  an  attempt 
should  be  made  to  prevent  ankylosis  or  whether  the 
process  should  be  favored. 

Taking  the  first  group,  which  comprises  the  more  im- 
portant joints  and  in  which  ankylosis  would  be  dis- 
astrous to  the  usefulness  of  the  animal,  we  find  it  im- 
possible, or  at  least  impracticable  in  the  larger  animals, 
to  bandage  these  parts.  If  the  joint  is  not  infected  by 
the  object  causing  the  injury,  it  is  almost  certain  to 
become  infected  by  exposure.     In  treating  these  cases 


168  WOUND  TREATMENT 

we  must  prevent  too  great  an  infection,  which  causes 
an  inflammation  and  destruction  of  the  capsule  and  car- 
tilage, and  thereby  results  in  ankylosis.  We  must  also 
be  careful  that  our  antiseptics  are  not  so  strong  as  to 
cause  some  irritation  to  the  joint  capsule  and  cartilage, 
producing  inflammation  as  well  as  increasing  the  chance 
for  infection  and  in  so  doing  hasten  the  destruction  of 
the  part. 

It  is  a  known  fact  that  most  of  our  antiseptics  cause 
irritation  to  the  tissues  even  in  a  strength  which  is  too 
mild  to  harm  bacteria.  Our  antiseptic  then  must  be  one 
that  not  only  prevents  the  growth  of  bacteria  but  also 
that  does  not  produce  irritation  of  the  tissues. 

We  have  found  pure  glycerin  to  be  an  agent  which 
produces  no  visible  irritation  of  the  tissues,  and  we  have 
also  found  that  bacteria  fail  to  multiply  upon  it.  Ac- 
cording to  Eideal  on  Disinfection  and  Preservation  of 
Food,  bacteria  and  insects  are  killed  by  undiluted 
glycerin,  since,  having  a  very  low  diffusive  power,  it 
causes  death  by  desiccation.  Spores  with  thicker  en- 
velopes resist  it  indefinitely,  and  on  dilution  of  the 
glycerin  begin  to  grow  immediately.  Cultures  made  in 
the  laboratory  of  Streptococcus  and  Staphylococcus,  and 
mixed  cultures  from  cases  of  fistulous  withers,  fail  to 
make  any  growth  on  glycerin.  The  injection,  under 
aseptic  conditions,  of  pure  warmed  glycerin  into  the 
hock  or  stifle  joint  of  a  horse  causes  the  animal  no  dis- 
tress, and  is  followed  by  no  increased  heat  in  the  part, 
no  pain  upon  pressure,  and  no  change  in  the  gait  of  the 
animal. 

We  find  also  that  when  we  inject,  under  aseptic  con- 
ditions, one  part  of  Lugol's  solution  to  four  parts  of 
glycerin,  or  in  other  words,  twenty-per-cent  Lugol's  solu- 
tion in  glycerin,  it  fails  likewise  to  cause  irritation. 


OPEN  JOINTS  169 

In  order  to  determine  the  amount  of  irritation  pro- 
duced by  glycerin,  we  injected  two  ounces,  slightly  warm, 
into  the  joint  capsule  of  a  horse.  Twenty- two  hours 
later  the  animal  was  killed.  It  had  shown  no  signs  of 
irritation,  ancl  the  capsule  of  the  joint  failed  to  show 
any  congestion.  Another  animal,  treated  in  the  same 
way,  was  killed  forty-eight  hours  after  injection,  and 
failed  to  show  any  symptoms,  and  the  joint  capsule  re- 
mained normal.  Two  other  animals  were  injected  in 
the  stifle  joint  in  the  same  manner.  One  was  killed  on 
the  third  day;  the  other,  at  the  end  of  two  weeks. 
Neither  showed  any  ill  effects  from  the  injection,  and 
the  joint  capsules  remained  normal.  In  all,  fourteen 
horses  were  injected,  and  none  showed  any  signs  of  a 
disturbance  in  the  joint. 

Later,  injections  of  twenty-per-cent  Lugol's  solution 
in  glycerin  were  made  in  the  same  manner,  and  the  ani- 
mals killed  at  intervals  of  four,  eighteen,  and  forty-eight 
hours,  and  three  weeks.  In  all,  we  were  unable  to  see 
that  any  irritation  had  been  produced. 

The  treatment  recommended  by  us  for  open  joints,  in 
which  we  wish  to  prevent  ankylosis,  is,  first,  to  shave  all 
hair  from  the  area  surrounding  the  wound,  following 
with  a  thorough  cleansing  of  the  skin  and  disinfection 
of  the  wound,  and  then  to  inject  a  twenty-per-cent  Lu- 
gol's solution  in  glycerin  into  the  wound.  This  should 
be  repeated  two  or  three  times  a  day,  each  time  enough 
of  the  solution  being  injected  to  fill  the  joint  capsule, 
thereby  securing  the  flushing  effect.  As  this  solution 
does  not  cause  irritation  to  the  tissue  and  yet.  is  a  strong 
antiseptic,  it  serves  to  shorten  the  period  of  congestion 
and  inflammation  and  to  overcome  the  infection  without 
causing  a  destruction  of  the  secreting  membrane  until 
the  external  wound  has  had  time  to  heal.  The  injection 
of  this  solution  seems  to  retard  the  excessive  secretion  of 


170  WOUND  TREATMENT 

synovia.  The  larger  the  joint  capsule  and  the  smaller 
the  external  wound,  the  longer  our  antiseptic  will  re- 
main in  contact  with  the  inflamed  tissues  as  the  glycerin, 
being  thick,  does  not  flow  through  a  small  opening. 

In  treating  the  second  group  of  open  joints,  those 
joints  in  which  ankylosis  does  not  impair  materially  the 
value  of  the  animal,  we  believe  the  treatment  should  be 
much  the  same  in  the  beginning  as  for  the  first  group. 
If  we  find  the  secreting  membranes  are  highly  infected 
and  cartilages  are  becoming  eroded,  ankylosis  is  bound 
to  occur,  and  we  should  direct  our  treatment  toward 
hastening  the  process. 

In  this  group  we  can  use  the  bandage  and  antiseptic 
pack  to  good  advantage,  as  all  of  these  joints  may  be 
readily  bandaged.  The  application  of  a  1/100  corrosive 
sublimate  or  other  antiseptic  pack  should  prevent  fur- 
ther infection  to  the  part.  In  making  the  pack,  we  have 
found  it  advisable  to  use  gauze  in  place  of  cotton,  as 
the  gauze  allows  the  secretion  to  pass  through  and  thus 
drain  away,  while  the  cotton  has  a  tendency  to  dam 
back  the  secretions  and  hold  them  in  contact  with  the 
wound,  thus  preventing  the  flushing  action  produced  by 
the  secretion  of  synovia.  The  free  discharge  of  synovia 
acts  as  a  flushing  agent  and  thus  carries  out  infection 
and  pus  from  the  joint  cavity.  The  proper  applica- 
tion of  the  pack  and  bandage  constitutes  the  first  prin- 
ciple in  the  treatment  of  inflammation — namely,  rest  to 
the  part — by  preventing  or  lessening  the  motion  of  the 
joint.  Motion  results  in  irritation  to  the  tissues  and 
promotes  infection.  We  may  render  the  joint  immov- 
able by  the  use  of  splints,  shoes  with  a  brace,  or  tar 
bandages  and  heavy  packs.  That  this  greatly  lessens 
the  infection  and  pain  is  shown  by  the  unusual  amount 
of  weight  the  animal  will  bear  on  the  part. 


OPEN  JOINTS  171 

By  making  a  free  opening  into  the  joint,  we  may  be 
able  to  curette  away  the  joint  cartilage  and  thus  hasten 
the  process  of  anlryiosis.  Then,  too,  by  increasing  the 
size  of  the  opening  into  the  joint,  we  have  a  better  oppor- 
tunity to  disinfect  thoroughly  the  joint  cavity,  overcome 
the  infection,  and  thus  prevent  fatal  sepsis.  Abscesses 
in  the  periarticular  tissue  should  be  opened  wherever 
they  occur  and  their  cavities  thoroughly  drained  and 
disinfected. 

For  the  purpose  of  disinfection  we  have  found  long 
narrow  strips  of  gauze  saturated  in  tincture  of  iodin 
to  be  of  great  benefit.  The  iodin  also  serves  as  more  or 
less  of  an  irritant,  and  causes  a  destruction  of  the  se- 
creting membranes  and  joint  cartilage  which  must  take 
place  before  we  may  hope  for  recovery. 

In  the  human  being  and  in  the  smaller  animals  there 
is  another  operation  which  may  be  resorted  to — ampu- 
tation. When  the  infected  area  is  great  and  there  is 
danger  of  death  from  septicemia,  the  removal  of  the 
distal  portion  of  the  member  allows  of  thorough  disin- 
fection of  the  joint,  as  well  as  the  removal  of  the  in- 
fected area  which  is  producing  the  sepsis. 

AVe  do  not  favor  the  use  of  slings  in  disease  of  the 
articulations,  believing  that  the  animal,  if  worth  treat- 
ing, is  able  to  get  up  and  down  readily  if  given  a  box 
stall  with  sufficient  room.  Certainly  a  horse,  if  given 
a  proper  amount  of  dry  bedding  to  prevent  decubical 
gangrene,  rests  more  comfortably  in  a  large  stall  than 
in  a  stiff  pair  of  slings.  Another  point  w^hich  is  often 
ignored  is  the  removal  of  the  shoes  from  a  horse  which 
is  spending  much  of  its  time  in  a  recumbent  position. 
The  bruising  of  the  pectoral  region  from  the  front  shoes, 
and  the  resulting  infection,  may  be  sufficient  to  over- 
come an  animal  that  is  fighting  to  withstand  the  attack 
of  septicemia  resulting  from  suppurative  arthritis. 


OPEN  JOINTS 

By  MART  R.  STEFFENS,  V.S.,  M.D.C. 

This  subject  will  be  considered  in  two  parts — open 
joints  of  recent  origin  in  fresh,  wounds,  and  those  of  a 
chronic  or  subacute  and  infected  character. 

Fresh  Wounds  Lacerating  a  Capsular  Ligament 

It  frequently  happens  as  the  result  of  accidents  that 
an  articulation  is  involved  in  the  trauma.  While  all 
accidental  wounds  in  veterinary  patients  are  to  be  con- 
sidered surgically  unclean,  it  is  well  not  to  carry  this 
theory  too  far.  Unless  much  extraneous  matter,  such 
as  hair,  chaff,  etc.,  has  entered  directly  into  the  articula- 
tion do  not  allow  antiseptic  solutions  to  penetrate  to  the 
synovial  surfaces  when  you  clean  up  such  a  wound. 

Swab  the  surroundings  as  clean  as  possible  with  a  cot- 
ton swab,  but  do  not  allow  any  of  the  solution  to  reach 
the  joint.  Nothing  seems  to  irritate  a  synovial  joint 
more  than  water. 

After  the  surrounding  parts  are  thoroughly  swabbed 
and  dried  with  clean,  dry  cotton,  the  wound  cavity  is 
completely  filled  with  chemically  pure  powdered  sodium 
bicarbonate,  some  of  which  is  even  gently  pressed  so  as 
to  enter  the  synovial  cavity.  It  is  important  that 
enough  be  used.  A  thin  layer  of  cotton  is  now  made 
to  cover  the  lesion  and  is  retained  either  with  col- 
lodion or  bandages. 

This  dressing  is  allowed  to  remain  for  twenty-four 
hours.  At  the  end  of  that  time  it  is  removed  and 
the  wound  carefully  inspected  for  synovia.     No  instru- 

173 


174  WOUND  TREATMENT 

mentation  is  permissible;  tlie  inspection  is  confined  to 
looking  into  the  wound  for  traces  of  synovia.  If  no 
synovia  is  to  be  seen  the  wound  is  treated  along  regular 
lines. 

If  synovia  is  present  in  the  wound  the  treatment  is 
repeated  as  on  the  first  occasion  and  again  left  on  for 
twenty-four  hours.  More  than  two  such  applications  are 
seldom  necessary,  and  unless  the  wound  has  been  very 
large  and  is  very  severely  infected,  good,  healthy  granu- 
lations and  no  synovia  are  present  after  the  first  twenty- 
four  or  forty-eight  hours. 

Chronic,  Infected,  Purulent  Joints 

The  treatment  of  these  is  radical.  While  it  happens 
now  and  then  that  cases  of  this  kind  recover  with  dila- 
tory methods  of  treatment,  it  is  only  by  radical  pro- 
cedure that  prompt  and  positive  results  can  be  ob- 
tained. 

The  various  articulations  of  the  equine  present  vary- 
ing degrees  of  severity  and  obstinacy  in  this  affection. 
The  elbow  joint  stands  at  the  head  of  the  list  of  fatal 
terminations.  I  would  class  the  coffin  joint  second. 
Next  in  order  I  would  place  the  hock ;  last,  the  stifle. 

The  following  method  of  treatment  is  always  suc- 
cessful in  cases  in  which  the  patient  has  not  become 
greatly  emaciated  and  still  retains  the  greater  part  of 
his  vitality  and  good  spirits.  It  is  successful  in  fifty 
per  cent  of  the  latter  cases,  but  it  is  of  no  avail  (nor  is 
any  other  treatment)  in  cases  where  the  patient  is  down 
and  refuses  to  eat.  Such  cases  rally  occasionally  for  a 
temporary  period,  only  to  go  down  again  later  and  die. 
If  the  surgeon  will  select  for  this  treatment  cases  which 
are,  while  moderately  grave,  still  in  good  general  con- 
dition, or  even  fair,  he  can  promise  his  client  good 
results.  • 


OPEN  JOINTS  175 

To  carry  out  this  treatment  properly  it  is  essential 
to  east  the  patient  either  on  the  ground  or  on  the 
table.     The  following  procedure  is  then  adopted: 

Thoroughly  cleanse  the  region  of  the  joint  involved, 
shave  and  scrub.  Irrigate  the  joint  cavity  for  at  least 
ten  minutes  with  a  solution  of  hydrargyrum  chloridum 
corrosium  (1  to  3,000)  at  body  temperature.  This  must 
be  done  with  the  utmost  antiseptic  precaution  and  great 
delicacy.  If  the  opening  in  the  joint  is  in  such  a  posi- 
tion that  good  drainage  cannot  be  obtained,  another 
opening  is  to  be  made  surgically  at  the  desired  point. 

Having  thoroughly  flushed  the  joint  cavity  with  the 
solution,  for  which  purpose  a  fountain  syringe  is  best, 
it  is  now  again  flushed  for  a  considerable  time  with 
sterile  physiological  saline  solution  at  body  tempera- 
ture. These  washings  are  to  be  discontinued  only  when 
the  fluid  comes  out  clear  and  free  from  pus,  flakes,  or 
detritus.  It  may  take  a  half  hour  of  continuous  irri- 
gation to  accomplish  this.  When  this  has  been  accom- 
plished the  interior  of  the  joint  may  be  considered  sur- 
gically clean  and  it  is  now  injected  with  the  following 
suspension : 

Hydrar.    lod.    Rub 3iv 

01.    Olivae    Pura 5iv 

M.     Sig.     Shake  before  using. 

This  is  to  be  injected  into  the  cavity  slowly  after 
plugging  up  all  openings  except  the  one  through  which 
it  is  to  be  introduced.  The  entire  quantity  is  injected 
so  as  to  be  sure  every  portion  of  the  interior  comes  in 
contact  with  the  suspension.  As  soon  as  this  is  done 
the  entire  joint  is  swathed  in  clean  cotton  held  in  place 
by  such  bandages  or  retaining  appliances  as  the  surgeon 's 
ingenuity  may  devise.  This  dressing  is  to  remain  in 
place   for  two  weeks. 


176  WOUND  TREATMENT 

In  nine  out  of  ten  cases  a  complete  cure  will  have 
been  effected  when  the  dressing  is  removed  at  the  end 
of  this  time.  Iji  rare  cases  it  may  be  necessary  to  repeat 
the  treatment.  It  is  very  important  that  the  entire 
joint  be  heavily  swathed  in  cotton  which  must  be  held 
snugly,  yet  not  tightly,  in  place. 

The  patient  must  be  kept  as  quiet  as  possible  until 
the  two  weeks  have  elapsed,  and  during  this  time  should 
receive  a  dram  of  hexamethylenamin  in  a  pail  of  drink- 
ing water  three  times  daily. 

Hexamethylenamin  is  of  much  value  in  various  forms 
of  arthritis;  it  has  been  found  that  it  is  excreted  by 
serous  membranes  and  it  has  been  demonstrated  to  be 
present  in  synovial  cavities  within  an  hour  or  two  after 
administration.  Its  antiseptic  action  is  due  to  formal- 
dehyde, which  is  liberated  during  the  process  of  elimi- 
nation. , 


TETANUS  FOLLOWING  SURGICAL 
WOUNDS 

By  HENRY  SMITH,  V.H.S. 

Up  to  the  present  time  tetanus  following  operation 
has  been  put  to  the  charge  of  the  surgeon.  The  impli- 
cation has  been  that  he  introduced  the  tetanus  through 
suture,  lotions,  dressings,  instruments,  sponges,  or  from 
his  own  hands  or  those  of  his  assistants — not  a  very 
comforting  reflection  for  the  surgeon.  Why  should  this 
tetanus  occur  in  spite  of  the  utmost  care  on  the  part 
of  the  surgeon?  I  believe  that  the  reason  is  explained 
by  Sir  David  Semple's  paper.  An  anaerobic  area  has 
been  left — the  sine  qua  non  for  the  development  of 
tetanus  from  tetanus  spores.  Sir  David  Semple  has 
shown  that  the  spores  of  tetanus  are  frequently  present 
in  the  human  intestine.  He  has  shown  that  when  tetanus 
spores  are  injected  into  a  given  area  of  a  guinea  pig,  and 
quinin  injected  into  a  different  area  of  the  same  guinea 
pig,  tetanus  bacilli  are  to  be  found  in  the  anaerobic 
slough  produced  by  the  quinin  and  nowhere  else,  and 
that  a  control  guinea  pig  which  has  similarly  received 
an  equal  number  of  spores,  but  has  not  received  any 
quinin,  is  not  affected  by  tetanus.  How  do  the  spores 
reach  the  anaerobic  area  in  this  case?  I  can  explain  it 
only  on  the  supposition  of  some  of  them  traveling 
through  the  blood  circuit  and  eventually  becoming 
stranded  in  the  area  of  dead  anaerobic  tissue,  where 
they  develop  into  toxin-producing  tetanus  bacilli. 


177 


FAVORITE  WOUND  TREATMENTS 

Applications  for  Successful  Wound  Treatment 

If  a  wound  is  to  be  stitched,  it  is  washed  out  with 
boiled  water  to  which  has  been  added  one  dram  mercuric 
chlorid  and  one-half  ounce  hydrochloric  acid  to  the  pint. 
Then  it  is  stitched  and  covered  with  plain  sterile  gauze, 
kept  moist  with  five-per-cent  solution  of  carbolic  acid  in 
boiled  water.  The  wound  is  dusted  daily  with  a  mix- 
ture of  boric  acid  and  iodoform.  On  wounds  not  closed 
by  sutures  I  use  the  following: 

Powdered  aloes,  one  ounce;  denatured  alcohol,  four 
ounces,  and  linseed  oil  as  much  as  will  suffice  to  make 
one  pint. 

These  treatments  or  applications  are  made  daily.  As 
far  as  results  are  concerned,  I  believe  I  get  primary 
union  as  often  as  any  of  the  general  practitioners  in 
the  rural  districts,  and  more  often  than  most  of  them. 

In  open  wounds  the  aloes-alcohol-and-linseed-oil  mix- 
ture is  a  sure  winner.  I  have  found  poor  animals  bound 
with  all  kinds  of  mechanical  devices  (most  of  them 
cruel  and  all  of  them  unnecessary),  to  keep  from  gnaw- 
ing and  biting  their  wounds.  I  have  never  seen  a  wound 
or  sore — surgical,  accidental,  or  constitutional — that  the 
animal  would  lick,  gnaw,  or  bite  after  the  above  dressing 
had  been 'used  twice  in  twenty- four  hours. 

P.  F.  Ash. 

Cenierville,  Iowa. 


179 


180  WOUND  TREATMENT 


Nail  Pricks 


Open  the  i)uncture  thorouglily  to  allow  good  drain- 
age, then  cleanse  the  parts  well  with  a  good  antiseptic, 
such  as  a  1-5000  bichlorid  solution,  and  in  severe  cases 
apply  the  following  freely,  twice  daily: 

lodin    cystals     3iv 

Sulphuric  ether Sviii 

Protect  the  wound  from  dirt  by  covering  with  cotton 

and  a  bandage,  and  as  an  external  protector,  a  piece  of 
burlap. 

I  have  given  this  treatment  a  good  trial  on  cases 
where  pus  had  burrowed  under  the  sole  considerably, 
and  have  had  the  best  of  results. 

Always  be  sure  to  give  free  drainage,  and  to  pro- 
tect the  wound  from  dirt  afterwards.  The  ether  in  the 
above  evaporates  rapidly  when  it  is  applied  and  leaves 
an  even  coating  of  iodin  over  the  wound,  which  pro- 
tects it  from  infection,  thus  allowing  rapid  healing  to 
take  place. 

I  have  used  this  treatment  in  cases  of  nail  prick  where 
the  swelling  extended  most  of  the  way  up  the  leg,  and 
have  seen  a  rapid  subsidence  of  all  swelling  after  a  few 
applications.  W.  P.  Bossenberger,  D.V.M! 

Williams,  Iowa. 


Wound  Dressings 

When  I  make  an  incision,  other  than  for  the  opening 
of  a  sinus  or  an  abscess,  I  use  a  dressing  of  l)oracic 
and  tannic  acids,  for  two  reasons:  I  want  to  protect 
the  Avound  against  outside  infection  and  I  want  the  skin 
and  stitches  dry  so  that,  barring  infection  while  operat- 
ing, I  shall  have  healing  ])y  first  intention.  The  same 
applies  to  accidental  wounds  that  are  fresh  and  can  be 
advantageously  stitched. 


FAVORITE  WOUND  TREATMENTS         181 

Where  there  is  pus  already  in  the  wound,  I  use  no 
antiseptics  or  dressings,  except  possibly  for  the  first 
cleansing,  or  rather  washing  out,  and  then  my  hobby 
is  a  light,  wine-colored  solution  of  potassium  perman- 
ganate or  a  normal  salt  solution.  In  this  class  of  wounds, 
bacterins  or  nuclein,  or  both,  get  me  the  results,  and  I 
let  the  wounds  alone.  I  simply  cleanse  around  the 
wound,  taking  care  to  keep  the  discharge  from  getting 
in  and  on  the  hair  as  far  as  possible. 

In  the  case  of  freshly  punctured  wounds,  if  deep,  I 
give  antitetanic  serum,  and,  of  course,  bacterins,  but 
let  the  wound  alone  after  having  secured  as  good  drain- 
age as  it  is  possible  to  give  it. 

Occasionally  a  wound  with  exuberant  granulations 
needs  tannic  acid  or  some  styptic  even  as  strong  as 
stibium  chlorid  to  hold  it  in  check. 

E.  M.  Bronson. 

Hartford  City,  Ind. 

Things  I  Have  Noticed  About  Wounds 

1.  Wire  cuts  do  better  in  the  summer  than  in  winter. 

2.  I  have  received  very  little  benefit  from  the  use  of 
bacterins  in  the  treatment  of  wire  cuts. 

3.  If  the  periosteum  is  injured  the  recovery  is  greatly 
retarded. 

4.  Peroxid  of  hydrogen  does  more  harm  than  good. 

5.  All   unnecessary   digital   manipulation    should   be 
avoided. 

6.  Wounds  across  the  face  heal  more  rapidly  than 
in  any  other  part  of  the  body. 

7.  Ro])e  burns  an^  harder  to  heal  than  wire  cuts. 

8.  The  majority  of  wire  cuts  come  after  an  electrical 
storm. 


182  WOUND  TREATMENT 

9.  Wounds  do  better  with  a  dry  dressing  than  with 
liquid  applications. 

10.  Bandages  as  a  rule  are  a  hindrance  rather  than 
a  help  toward  rapid  recovery. 

11.  The  use  of  slings  is  very  beneficial  in  the  treat- 
ment of  open  joints  of  all  kinds. 

12.  Ointments  of  all  kinds  are  filth  gatherers. 

13.  The  common  barn  sponge  has  no  place  in  the 
modern   wound   treatment. 

14.  And  lastly,  the  teats  in  cows  are  practically  the 
only  part  of  their  anatomy  that  becomes  injured  from 
barbed  wire,  and  beware,  young  man,  when  treating 
them.  F.  H.  Burt,  M.D.C. 

Clienoa,  III. 


INDEX 


Abdominal  wounds   155 

Asepsis 75 

Aseptic,  definition  of 33 

Aseptic,  incised  wounds 93 

Aseptic  surgery 33,  129 

Aseptic  surgery,  hindrances  to 39 

Accidental  wounds 48,  62 

Actinomyces   42 

Air  as  a  conveyor  of  infection 76 

Anderson-McClintic  method   9 

Ankylosis    167 

Antiseptics 7,  33 

Antiseptics,  factors  affecting  action  of 14 

Antiseptic  surgery 33 

Bacillus  coli  communis 42 

Bacillus  of  malignant  edema 42 

Bacillus  of  necrosis 42 

Bacillus  pyocyaneus   42 

Bacillus  of  tetanus ' 42 

Bacillus   tuberculosis    42 

Bacterins  in  wound  treatment 125 

Botryomyces 42 

Carbo-campho 21 

Carbolic   acid 8 

Castration   61 

Cauterization    14 

Chronic,  infected,  purulent  joints 174 

Classification  of  wounds 92,  125 

Cleansing  and  disinfecting  wounds 48 

Contusions  with  subsurface  solution  of  continuity 156 

183      .     * 


184  WOUND  TREATMKNT 

Cost  of  better  wound  treatment 74 

Creolin-Pearson    19 

Deodorant    33 

Disinfectants 7,  33 

Disinfection 48,  100,  143 

Drainage  of  wounds 49 

Draining  tubes 88 

Drainage  wicks ; 88 

Dressings  as  conveyors  of  infection 89 

Dressing  for  nail  pricks 180 

Dressing  for  open  joints 175 

Dressings  for  wounds 153,  180 

Epistaxis    62 

Eventration  without  visceral  perforation 163 

Exuberant  granulation 134 

Fetlock  wounds   52 

Flexor  tendon  sheath  wounds 53 

Foot  wounds 53 

Foreign  bodies  49 

Formulae  for  wound  dressings 153,  175,  179,  180 

Glycerin  as  an  antiseptic 1G8 

Gunshot  wounds 122 

Hands,  surgeon  's  and  assistant 's 80 

Healing  of  wounds 149 

Healing  of  wounds,  how  accomplished 126 

Hemorrhage    48,  57 

HexamethyleiLamin 17() 

Human  and  veterinary  surgery  contrasted 38 

Infection  by  air 43,  76 

Infection  by  dressings 89 

Infection  by  instruments 79 

Infection  by  water 43 

Infection,  circumstances  predisposing 43 

Infection  from  miscellaneous  sources 43 

Infection  from  the  surgical  field.' 90 


INDEX  185 

Infection,  postoperative 90 

Infection,  varieties  of 41 

Instruments  as  conveyors  of  infection 79 

Kerosene  as  a  disinfectant 112 

Knee  wounds    53 

Lacerations  of  capsular  ligaments 173 

Lacerations  without   eventration.  .  . ,  ; 160 

Liquor  cresolis 52 

Lister,  tlie  work  of 27 

Lugol  's   solution    168 

Metracresol  9 

Nail  pricks    ISO 

Open  joints    165,  173 

Open   wounds 109 

Organisms,  resistance  of 15 

Orthof orm    134 

Packing  for  wounds 88 

Paracresol    9 

Phenol   coefficient IS 

Postoperative  infection 90 

Postoperative  treatment  of  wounds G9 

Puncture   wounds 52,   119 

Pus    organisms 16 

Repair  of  wounds 131 

Resistance  of  organisms 15 

Restraint    99 

Rideal-Walker  method   9 

Schools  of  surgery ■ 33 

Septic   wounds 32 

Skill  in  surgery 139 

Skin,  suturing  the 105 

Solutions  and  their  containers 84 


186  WOUND  TREATMENT 

Sponges    83 

Staphylococcus  pyogenes  albus 41 

Staphylococcus  pyogenes  aureus 41 

Staphylococcus  pyogenes  citreus 41 

Sterilization    146 

Sterilization  of  instruments 45 

Streptococcus    equi 42 

Streptococcus  erysipelatis 42 

Streptococcus  pyogenes 42 

Subsurface  loss  of  tissues 95 

Suppurative  arthritis 165,  173 

Surgeon 's  and  assistant 's  hands 80 

Surgical  dressings 51 

Surgical  field  as  a  conveyor  of  infection 90 

Sutures    49,  86 

Suturing  the  skin  flap 105 

Tetanus    177 

Thymol 8 

Tumors 59 

Union  by  first  intention 44 

Union  by  granulation  and  cicatrization 44 

Union  under  a  scab 44 

Varicose    ulcers 134 

Venomous  wounds 113 

Veterinary  and  human  surgery  contrasted 38 

Veterinary  surgery,  progress  in 25 

Visceral  perforations 164 

Wire    cuts 181 


Webster  Family  Library  of  Veterinary  Medicine 
Cumnnings  School  of  Veterinary  Medicine  at 
Tufts  University 
200  Westboro  Road 
North  Gratton,  MA  01536 


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